Approved form AF2002-150

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 25
(see r 34)

Application for appointment of new arbitrator
[Heading as in Request for arbitration]
A.B.									of [address]			[description]		         Applicant,					    and
C.D.									of [address]			[description]		       Respondent.
Application is made to the Court on behalf of the applicant	              to appoint a new arbitrator in this matter in the place of Ms/Mr	        , the arbitrator appointed in this matter, by reason of the death [or refusal] [or inability to act] of the said Ms/Mr.
And the applicant requests that a time and place may be fixed for the hearing of the application.
Dated: 							
(Signed)	
Applicant.
[Or, Applicant’s solicitor or Agent.]

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