FORM OF NOTICE BY COMMISSIONER COMMUNICATING REFUSAL FOR REGISTRATION OF AGREEMENT BETWEEN EMPLOYER AND WORKMAN REGARDING COMPENSATION

Last Updated: September 22, 2023By

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

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