Approved form AF2002-140

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 15
(see r 21)
Notice of acceptance of weekly sum offered, or of willingness to accept sum paid into court
[Heading as in Request for arbitration.]
TAKE NOTICE—
That the applicant, A.B.,	            ccepts the weekly sum offered by the respondent, C.D.			   [or the sum of		              paid into Court] in satisfaction of his or her claim in this matter [or that the applicant, E.F.,	            [or the respondent, G.H.,			] is willing to accept the sum of		 paid into Court by the respondent, C.D.,		     in satisfaction of the compensation payable in this matter].
But the applicant			[or the respondent, G.H.	              ] will apply to the Court to include in its award an order directing the  respondent, C.D.,		to pay the costs properly incurred by the applicant 		            [or the respondent, G.H.,			       ] before the receipt of notice of the offer of the said weekly sum [or of notice of payment of the said sum of		        into Court], and his or her costs properly incurred in relation to the notice of the offer of the said weekly sum [or the notice of payment of the said sum of		    into Court], and to this notice, and in attending at the Court to obtain an award.
Dated: 						
(Signed)			
Applicant,
or
Respondent.
To the Registrar of the Magistrates Court, and
To the respondent, C.D., and
To the applicant, A.B., and
To the respondents [naming them.]

Endnotes
1	This form was originally in the Workers Compensation Rules 1938, schedule 1.  Under amendments made by the Legislation (Consequential Amendments) Act 2001, the form was omitted from the rules and became a form approved under the rules, rule 89 (see amdt 1.2805, amdt 1.2807).
2	This republication includes amendments made under the Legislation Act 2001, part 11.3 (Editorial changes).

©  Australian Capital Territory 2002