Approved form AF2002-172

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 47
(see r 54)
Application for variation of order or award
[Heading as in award or memorandum.]
TAKE NOTICE, that I [name and address of applicant] intend to apply to the Magistrates Court at Canberra on						, at 					, for an order that the order of the Court [or the award] made in the above-mentioned matter on the			day of			as to the apportionment of the sum paid as compensation among the dependants of A.B.			deceased, [or as to the manner in which the sum payable to		                      a dependant of A.B.		deceased, is to be invested, applied, or otherwise dealt with]	           may be varied by directing [here state variation claimed by applicant] and for consequential directions.  And further take notice that the circumstances in which this application is made are [state particulars.]
Dated:
(Signed)
Applicant.
[or	           Applicant’s solicitor or agent.]
To the Registrar of the Magistrates Court,
and to [all persons 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