FORM OF NOTICE BY COMMISSIONER COMMUNICATING REFUSAL FOR REGISTRATION

FORM OF NOTICE BY COMMISSIONER COMMUNICATING REFUSAL FOR REGISTRATION

FORM OF NOTICE BY COMMISSIONER COMMUNICATING REFUSAL FOR REGISTRATION

FORM OF NOTICE BY COMMISSIONER COMMUNICATING REFUSAL FOR REGISTRATION

OF AGREEMENT BETWEEN

EMPLOYER AND WORKMAN REGARDING COMPENSATION

Form O
[See rules 49 and 50]

Take notice that registration of the agreement to pay compensation said to have been reached
between you…………and ………………on the………………20………………has been refused for
the following reasons, namely:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………
Dated………………20……..
Commissioner