Approved form AF2002-194

made under the
Workers Compensation Rules 1938

Workers Compensation Rules 1938— Form 69
(see r 87)
The Workers Compensation Act 1951
Special register
column 1
No of matter	column 2
Title	column 3
Date of proceedings	column 4
Nature	
1	In the matter of an arbitration between A.B., of, etc, applicant, and C.D. of, etc, respondent.	(dates)	Request for arbitration filed, and copy sent to Magistrate.
Day for arbitration fixed.
Notice of day fixed sent to applicant, and notice with copy request sent to respondent by registered post.
Respondent’s answer filed; copy sent to applicant.
Arbitration held;         appointed as medical referee to report; further hearing adjourned.
Report of medical referee received; notice given to the parties.
Further hearing. Award made as follows (enter minute of award).
	for costs paid into Court by respondents.
	for costs paid to applicant’s solicitor.
	
2	In the matter of an agreement between A.B., of, and E.F. of, &c.		Memorandum of agreement as to compensation, signed by A.B., left to be recorded.
Notice and copy memorandum sent by post to E.F.
Notice received from E.F. disputing memorandum.
Notice sent to A.B. that memorandum is disputed, and will not be recorded without consent in writing of E.F., or order of the Court.
Application on behalf of A.B. that memorandum be recorded.
Application heard, and order made that memorandum be recorded with alterations.
Memorandum recorded as follows [set out memorandum].
Execution issued for costs.
etc.

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