Approved form AF2002-160

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 35
(see r 45 (1))

Application for removal of record of memorandum of agreement from register under schedule 4, clause 9, proviso (e) to the Act
[Heading as in memorandum.]
TAKE NOTICE, that I intend to apply to the Magistrates Court at Canberra on								, for an order for the removal from the register of the record of the memorandum of the agreement in this matter which was recorded on 				, under the Workers Compensation Act 1951, schedule 4, clause 9, proviso (e), on the ground that the said agreement was obtained by fraud [or undue influence or improper means],		                       and for consequential directions, and for costs.
Dated:
								               Applicant.		
[Or Applicant’s solicitor or agent.]
To the Registrar of the Magistrates Court					 and to [all parties interested.]

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