Approved form AF2002-183

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 58
(see r 64)

Notice of application for determination of amount of solicitor’s or agent’s costs
[Heading as in award or memorandum.]
Take Notice, that I intend to apply to the Magistrates Court, Canberra, on					, to determine the amount of costs to be paid to me as solicitor [or agent] for you, A.B.			 in this matter; and for an order declaring that I am entitled to recover such amount from the person for whom I acted or to a lien for such amount on or to deduct such amount from the sum awarded or agreed as compensation to you 			in this matter, and for consequential directions.
Dated:
Applicant.
To the Registrar of the Magistrates Court, Canberra.			             and to									         A.B.			of

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