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Learner (XYZ)     13 December 2010

WCA claim application format required.

In a death case, the format of claim application under Workmen Compensation Act is required.

I have searched the "Shared Files" coloumn but found none.

One may paste it here or share in "shared files" column for helping access others too and paste the link here.

I shall be very thankful.



Learning

 4 Replies

SALA SATEESH (lawyer)     13 December 2010

Dear Friend,

 

as per the workmen's compensation act under s.10 of the act the application as prescribed in form-F should be drafted.

 

Regards,

S.Sateesh

Kirti Kar Tripathi (lawyer)     14 December 2010

the formate is already in rules, you may copy and fill  required informations.

Learner (XYZ)     16 December 2010

!!

I know it is that simple but would be grateful if u paste one!

Kirti Kar Tripathi (lawyer)     17 December 2010

 

Dear friend

I am sending you the format of WCA application under the rules
FORM F
(See rule 20)
APPLICATION FOR COMPENSATION BY WORKMAN
To 
The Commissioner for Workmen’s Compensation, 
 .................................................................

 ............ residing at......................................................................................applicant, 
 Versus  
 residing at............................................................................................opposite party. 
 It is hereby submitted that— 
(1) the applicant, a workman employed by (a contractor with) the opposite party on the 
 day of...................................20...... received personal injury by accident ..............
arising out of and in the course of his employment.
The cause of the injury was (here insert briefly in ordinary language the cause of the 
injury)...................................................................................................................... 
 ............................................................................................................................... 
(2)  The applicant sustained the following injuries, namely:— 
  ............................................................................................................................... 
 (3) The monthly wages of the applicant amounts to  Rs 
 ........................................................
 The applicant is over/under the age of 15 years. 
*(4) (a) Notice of the accident was served on the ............... day of 
 .......................................
(b)  Notice was served as soon as practicable. 
(c)  Notice of the accident was not served (in due  time) by reason of 
 ...............................
(5) The applicant is accordingly entitled to receive— 
(a) half-monthly payment of Rs.......from the............ day of ........20..... 
to......................(b) a lump sum payment of Rs ..................................................... 
(6) The applicant has taken the following steps to  secure a settlement by agreement, 
namely .................................but it has  proved impossible to settle the questions in 
dispute 
because.................................................................................................................... 
You are therefore requested to determine the following questions in dispute, 
namely:— 
(a)  whether the applicant is a workman within the meaning of the Act;   
(b)  whether the accident arose out of or in the course of the applicant’s employment; 
(c)  whether the amount of compensation claimed is due, or any part of that amount; 
(d)  whether the opposition party is liable to pay such compensation as is due; 
(e)  etc. (as required).  
Dated ........................        Applicant.  


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