Approved form AF2002-166

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 41
(see r 49, 50 and r 51 (3))
Application for investment and application of the amount allotted to any person
(Heading as in præcipe for payment into court.)
TAKE NOTICE, that I [name and address of applicant] intend to apply to the Magistrates Court at Canberra on					, at 				, on behalf of myself [or of		           ] for an order for the investment and application of the sum paid into Court in this matter and allotted to me [or to 			].
I intend to apply for an order for the investment and application of the said sum as follows:
[state how applicant wishes the sum to be dealt with.]
or in such other manner as the Court in its discretion thinks fit for my benefit [or for the benefit of 				], and for consequential directions.
Dated:
(Signed)
To the Registrar of the Magistrates Court.

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