Approved form AF2002-182

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 57
(see r 57 (15))

Notice by registrar to employer of receipt of medical certificate and declaration of identity
[Heading as in award or memorandum.]
Take Notice, that I have received proof of identity and of continuance of incapacity in this matter.
And I request you to forward the sum of			 , being the amount of weekly payments payable to A.B.			under the award [or memorandum] from [the date to which they were last paid 		] to	         [13 weeks from that date] to me, to be by me transmitted to A.B.
Dated:
Registrar of the Magistrates Court.
To [name and address of employer].

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