memorandum of such reference, and of the direc- Appndx.
tions of the judge, and the subsequent proceedings
and order thereon;

(15.) A memorandum of the result of every taxation or
review of taxation of costs under any such
memorandum, or under any award or order;

(16.) A memorandum of every application to rectify the register in respect of any memorandum, and of the proceedings and order thereon;

(17.) A memorandum of every application or report with reference to the removal of the record of a memorandum of an agreement from the register, and of the subsequent proceedings and order thereon;

(18.) A memorandum of every application to the judge or arbitrator, under paragraph 14 of the second schedule to the Act, to determine the amount of costs to be paid to a solicitor or agent, and of the proceedings and order thereon, and of the result of any taxation or review of taxation under such order;

(19.) A copy of every certificate under sub-section 4 of section 1 of the Act given by the court or sent to the registrar from any other court;

(20.) A memorandum of every proceeding taken in the
court for the enforcement of any award, order,
memorandum, or certificate, and of the result of
such proceeding;

(21.) A memorandum of every application to refer a
matter to a medical referee pursuant to para-
graph 15 of the first schedule of the Act, and of
the order and subsequent proceedings thereon;
(22.) A memorandum of every application to the court
for the suspension of the right to compensation
or to take or prosecute any proceedings under the
Act in relation to compensation, or of the right
to weekly payments, and of the proceedings and
order thereon;

(23.) A memorandum of every sum paid into court
pursuant to paragraph 5 of the first schedule to
the Act, or under any award, memorandum, or
certificate;

(24.) A memorandum of every application made to the court with reference to any such sum, and of every order made on such application, and of the manner in which such sum is invested, applied, or disposed of;

(25.) A memorandum of every application for the payment of any weekly payment into court, and of the proceedings and order thereon, and of the

Appndx.

References

to medical referees.

directions given as to the payment out or application of any such weekly payment;

(26.) A memorandum of every application for variation of an order of the court as to the apportionment, investment, or application of any sum paid as compensation, and of the proceedings and order thereon;

(27.) A memorandum of every application to refer a matter to a medical referee pursuant to paragraph 18 of the first schedule to the Act in the case of a workman intending to cease to reside in the United Kingdom, and of the order and the proceedings thereon; and of every certificate and declaration of identity and request for payment received from such workman, and of the proceedings thereon;

(28.) A memorandum of every application to set aside or vary an award or order under Rule 70, and of the proceedings and order thereon;

(29.) A memorandum of every certified copy given pursuant to Rule 74, or a copy of every certified copy filed pursuant to that Rule;

(30.) A memorandum of every application for transfer
and of the order thereon, and the proceedings
under such order;

(31.) A memorandum of the transmission of documents
and certified copies pursuant to paragraph 11 of
Rule 37 or paragraphs (iii.) or (iv.) of Rule 38;
(32.) A memorandum of the transfer of any money paid
into court to any other court;

(33.) The like memorandum as to every matter trans-
ferred, or document or certified copy transmitted
or money transferred to the court, as would have
been recorded as to such matter, document, or
money if it had been originally commenced and
prosecuted in or transmitted to or paid into the
court;

(34.) A memorandum of any other matter which the judge shall order to be recorded with reference to any matter brought into or proceeding taken in the court under the Act.

References to Medical Referees.

82.-(1.) Where a medical referee is summoned as an assessor, or any matter is referred to a medical referee, such referee shall be summoned or the matter shall be referred subject to and in accordance with any regulations made by the Secretary of State and the Treasury; and any such regulations shall so far as they affect the county court or an arbitrator appointed by the judge of the

county court, and proceedings in the county court or Appndx. before any such arbitrator, be deemed to be Rules of Court, and shall have effect accordingly.

under Act.

8. 8 (1) (ƒ).

(2.) In particular, if such regulations as in the preceding References paragraph mentioned provide that an employer or a workman who desires any matter to be referred to a medical referee under paragraph (ƒ) of sub-section 1 of section 8 of the Act shall apply to the registrar of a county court for the matter to be so referred, it shall be the duty of the registrar to refer the same in accordance with such regulations.

references.

(3.) The registrar shall keep a record in the form pre- Record and scribed by regulations made by the Secretary of State of returns as to all cases in which medical referees are summoned as assessors or matters are referred to medical referees, and shall forward a copy of the same to the Secretary of State at such times as may be prescribed by such regulations.

Matters, how distinguished.

83. Every matter brought into the court under the Act Matters, shall be intituled in the matter of the Act, and shall be how distinguished. distinguished by a separate number; and all documents filed and subsequent proceedings taken in the court with reference to such matter shall be intituled in like manner, and shall be distinguished by the same number; and the entries made in the special register with respect to each such matter shall be entered together, and shall be kept separate from the entries with respect to any other matter.

Forms.

84. The forms in the Appendix, where applicable, and Forms in where they are not applicable forms of the like character, like forms Appendix or with such variations as the circumstances may require, may be used. may be used in proceedings under the Act.

APPENDIX (k).

FORM 1.

Application for Arbitration by Injured Workman with respect to the Compensation payable to him.

In the County Court of

holden at

In the matter of the Workmen's Compensation Act, 1906.

1. On the

of (address)
(description)
day of

Respondent.

[or by

a

a con

personal injury by accident arising out of and in the course of his employment was caused to A.B. workman employed by C.D. & Co., Limited, tractor with C.D. & Co., Limited, taken by them].

for the execution of work under

2. A question has [or Questions have] arisen

[here state the questions, specifying only those which have arisen, e.g.]— (a) as to whether the said A.B.

above-mentioned Act applies: or

is a workman to whom the

(b) as to the liability of the said C.D. & Co., Limited,

to pay

compensation under the above-mentioned Act in respect of the said injury: or

(c) as to the amount [or duration] of the compensation payable by the said C.D. & Co., Limited,

to the said A.B.

under the above-mentioned Act in respect of the said injury.

[or as the case may be.]

3. An arbitration under the above-mentioned Act is hereby requested between the said A.B. and the said C.D. & Co., Limited,

the settlement of the said question [or questions]. 4. Particulars are hereto appended [or annexed].

PARTICULARS.

1. Name and address of applicant.

2. Name, place of business, and nature of business of respondent.

3. Nature of employment of applicant at time of accident, and whether employed under respondent or under a contractor with him. [If employed under a contractor who is not a respondent, name and place of business of contractor to be stated.]

4. Date and place of accident, nature of work on which workman was then engaged, and nature of accident and cause of injury. 5. Nature of injury.

6. Particulars of incapacity for work, whether total or partial, and estimated duration of incapacity.

7. Average weekly earnings during the twelve months previous to the injury, if the applicant had been so long employed under

for

(k) These Forms are as amended and altered by the W. C. Rules of 1908 and 1909.

PARTICULARS-continued.

the employer by whom he was immediately employed, or if not,
during any less period during which he has been so employed.
8. Average weekly amount which the applicant is earning or
is able to earn in some suitable employment or business after
the accident.

9. Payment, allowance or benefit received from employer during the period of incapacity.

10. Amount claimed as compensation.

11. Date of service of statutory notice of accident on respondent, and whether given before workman voluntarily left the employment in which he was injured. [A copy of the notice to be annexed.]

12. If notice not served, reason for omission to serve same.
The names and addresses of the applicant and his solicitor are:
Of the Applicant,

Of his Solicitor,

The name and address of the respondent to be served with this application are:

Application for Arbitration by or on behalf of Dependants of Deceased Workman, with respect to the Compensation payable in respect of the Injury to such Dependants, where Death has resulted from an Injury to the Workman, and the Settlement of Questions as to who are Dependants, and the Apportionment and Application of such Compensation.

of

In the County Court of

holden at

In the matter of the Workmen's Compensation Act, 1906.
No. of Matter

1. On the

In the matter of an Arbitration between

E.F.
of (address)
(description).

C.D. & Co., Limited,

G.H.

of (address)
(description)
and

of (address)
(description)..
day of

Applicant,

and

[or as the case may be; see Rule 4.]

Respondents.

personal injury by accident arising out late

day of

for the executhe

of and in the course of his employment was caused to A.B.
deceased, a workman employed by C.D. & Co., Limited,
[or by a contractor with C.D. & Co., Limited,
tion of work undertaken by them,] and on the
death of the said A.B. resulted from the injury.