Approved form AF2002-155

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 30
(see r 39)
Notice disputing genuineness of memorandum, or notice by employer objecting to memorandum being recorded
[Heading as in memorandum.]
	(1)	Notice disputing genuineness of memorandum.
TAKE NOTICE that			[state name of party disputing], a party [or parties] interested, disputes [or dispute] the genuineness of the memorandum sent to you for registration in this matter on the following grounds:
[here state the grounds, as eg]
	(a)	That no such agreement has in fact been entered into; or
	(b)	That the terms of the agreement are not correctly stated in the memorandum of agreement; or
	(c)	That the agreement is no longer subsisting or enforceable; or
	(d)	That the agreement is not enforceable by reason of its having been entered into under a mutual mistake [or having been obtained by fraud] [or undue influence] [or improper means].
Dated:
[To be signed by the party disputing or his or her solicitor (or agent), or in case of employers by their duly authorized official, employee, or agent.]
To the Registrar of the Magistrates Court, Canberra.
	(2)	Notice by employer objecting to memorandum being recorded.
TAKE NOTICE that 			[state name of employer] objects [or object] to the memorandum sent to you for registration in this matter being recorded on the ground that				[worker] has in fact returned to work and is earning the same wages as he or she did before the injury.
Dated:
[To be signed by the employer or his or her solicitor (or agent) or duly authorized official, employee, or agent.]
To the Registrar of the Magistrates Court, Canberra.

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