Approved form AF2002-192

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 67
(see r 76)
Summons to medical referee to sit as assessor
[Heading as in request for arbitration.]
Dated:
You are summoned to attend and sit with the Court as an assessor at		        on								, at 							.
To 								         of
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