1
Employees Compensation Regulations
STATUTORY RULES.
1930. No. 134.
REGULATIONS UNDER THE COMMONWEALTH EMPLOYEES’ COMPENSATION ACT 1930.
I, THE person administering the Government of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Commonwealth Employees’ Compensation Act 1930, to come into operation on the date of the commencement of that Act.
Dated this Sixth day of November, One thousand nine hundred and thirty.
Administering the Government of the
Commonwealth of Australia.
By His Excellency’s Command,
Acting Treasurer.
———
Employees’ Compensation Regulations.
Short title.
- These Regulations may be cited as the Employees’ Compensation Regulations.
Definitions.
2.—(1.) In these Regulations, unless the contrary intention appears—
“Authority” means an Authority under the Commonwealth specified in Regulation 14 of these Regulations;
“the Act” means the Commonwealth Employees’ Compensation Act 1930.
(2.) Any reference in these Regulations to a Form shall be read as a reference to a Form in the Schedule to these Regulations.
Claim by employee.
- Any employee claiming compensation under the Act shall deliver or send by post to the Permanent Head or Chief Officer of the Department or Authority in or by which the employee was employed at the time the claim arose, or to the officer in charge of the work on which the employee was so employed, a claim for compensation in accordance with Form A.
Claim by dependant.
- Any dependant claiming compensation under the Act in respect of the death of an employee shall deliver or send by post to the Permanent Head or Chief Officer of the Department, or Authority in or by which the employee was employed at the time the claim arose, or to the officer in charge of the work on which the employee was so employed, a claim for compensation in accordance with Form B.
Fees to Medical Referees.
- The fees payable to a medical referee shall be as follow:—
| £ | s. | d. | |
|---|---|---|---|
| For a first examination.................................... | 2 | 2 | 0 |
| For a subsequent examination................................ | 1 | 1 | 0 |
Medical examinations.
- The medical referee, medical practitioner, or medical board to whom any matter is referred, shall give a certificate in accordance with Form C and shall forward such certificate to the Commissioner or his delegate as soon as possible after the examination.
Frequency of Medical Examinations.
- Where an employee has made a claim for compensation or is in receipt of weekly payments under the Act, he shall not be required, after a period of one month has elapsed from the date on which, the first payment of compensation was made, to submit himself against his will for examination by a medical referee, a medical board, or a medical practitioner provided and paid by the Commonwealth, except as follows:—
At reasonable hours, once a week during the second mouth, and once a month during the third, fourth, fifth, and sixth months after the date of the first payment, and thereafter once in every two months.
Nomination by employee of representative on Medical Board.
- Where an employee is required by the Commissioner in pursuance of section 19 of the Act to submit himself for examination by a medical board, any nomination by the employee of a medical practitioner as one of the members of the board shall be lodged with the Commissioner within seven days of the date of the notification by the Commissioner to the employee requiring him to submit himself for examination.
Appointment of medical boards.
- The Commissioner may, from time to time, appoint such medical boards as are required.
Election under section 15 of the Act.
- An employee may make an election under section 15 of the Act in accordance with Form E.
Appeals.
11.—(1.) An appeal under section 20 of the Act may be instituted by notice of appeal in accordance with this regulation.
(2.) The person appealing shall, within twenty-one days after the determination or action appealed against is made or taken, serve the notice of appeal on the Commissioner and shall file a copy of the notice of appeal in the County Court.
(3.) The notice of appeal shall state the grounds of appeal.
Returns by Departments.
- The permanent head or chief officer of each Department and authority shall furnish to the Commissioner not later than 31st day of July, in each year, a correct return in accordance with Form D of payments made under this Act during the previous twelve months ended 30th day of June.
Returns by Commissioner to Treasurer.
- As soon as possible after the close of each financial year the Commissioner shall furnish to the Treasurer a correct return specifying—
(a) the number of cases in respect of which compensation has been paid under the Act during the previous year;
(b) the amount of compensation paid during that year; and
(c) the amount paid in respect of medical, hospital, and funeral expenses, during that year.
Commonwealth Authorities.
- The authorities under the Commonwealth to employees of which the application of the Act shall extend shall be as follows:—
Commonwealth Bank of Australia.
Commonwealth Savings Bank of Australia.
Repatriation Commission.
War Service Homes Commission.
Commonwealth Railways.
Australian Commonwealth Shipping Board.
Council for Scientific and Industrial Research.
North Australia Commission.
Compliance with Forms.
- Strict compliance with the forms in the Schedule shall not be required and substantial compliance shall suffice for the purposes of these Regulations.
Declarations.
- Declarations under these Regulations may be made before any of the following persons:—
A postmaster or postmistress, or person in charge of a post office, a police stipendiary or special magistrate of the Commonwealth or of a State, a justice of the peace, a barrister or solicitor, a State school head teacher, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a commissioner for declarations, a minister of religion, a member of the Parliament of the Commonwealth or of a State, or a councillor or alderman of any municipality or shire.
————
THE SCHEDULE.
Form A.
——
Commonwealth Employees’ Compensation Act 1930.
——
CLAIM FOR COMPENSATION.
——
Claim by Incapacitated Employee.
To *...................
I, [here write full name].......................................................of [here write full postal address] ............................................................hereby claim compensation under the above-mentioned Act in respect of personal injury sustained by me and arising out
of and in the course of my employment and declare that, to the best of my knowledge and belief, the following replies to the questions and requests for information are true and correct in every particular:—
| Questions and requests for Information. | Replies. |
|---|---|
| In what capacity and by what Department or Authority were you employed at the time of your injury? | |
| State the nature of your injury; also how, when and where it was caused. | |
| If you are claiming in respect of incapacity arising from an industrial disease:—(a) What is nature of the disease?(b) When was it caused?(c) When were you first incapacitated by such disease?(d) What was the nature of your employment and for what period were you engaged thereon?(e) If you have previously suffered from such disease state:—(i) The approximate date on which it first manifested itself.(ii) The extent to which it interfered with your employment | |
| Was notice of the accident or incapacity served? If so, on whom, and on what date? | |
| Have you engaged in any employment since the date of your injury or incapacity? If so, give full particulars. | |
| If this claim is made more than six months after the occurrence of the accident or incapacity, give reasons for failure to make the claim within that period. | |
| Have you a claim against the Commonwealth or any person for compensation, or for any payment in respect of the injury under any other law in force in the Commonwealth or any other place? |
If you have any living children under the age of fourteen years and in respect of whom you are not receiving any payment by way of child endowment, give particulars:—
| Full names of children. | Dates of birth. | Extent of dependence on employee at time of injury. |
|---|---|---|
Declared at..............on the..............day of....................19 .
Signature of Declarant....................
Before me †............................
‡............................
* The claim should be addressed to the Permanent Head or Chief Officer of the Department or Authority in or by which the employee was employed at the time of the accident, or to the officer in charge of the work on which the employee was so employed.
† The person before whom this declaration is made to sign here and add the title by which he takes the declaration, such as “Postmaster,” &c.
‡ The declaration may be made before any of the following persons:—
A postmaster or postmistress, or person in charge of a post office, a police stipendiary or special magistrate of the Commonwealth or of a State, a justice of the peace, a barrister or solicitor, a State school head teacher, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a commissioner for declarations, a minister of religion, a member of the Parliament of the Commonwealth or of a State, or a councillor or alderman of any municipality or shire.
Form B.
Commonwealth Employees’ Compensation Act 1930.
——
CLAIM FOR COMPENSATION.
——
Claim by Dependant of Employee.
To *...................
.........................
I, [here write full name].......................................................of [here write full postal address] ............................................................hereby claim compensation under the above-mentioned Act for myself and the children named below in respect of the death of [here write full name of deceased employee]............................................, and declare that, to the best of my knowledge and belief, the following replies to the questions and requests for information are true and correct in every particular:—
| Questions and requests for Information. | Replies. |
|---|---|
| In what capacity and by what Department or Authority was the above-named employee employed at the time of his injury? | |
| State the nature of such injury; also how, when and where it was caused.If the death of the employee was caused by an industrial disease:—(a) What was nature of disease?(b) When was it caused?(c) When was he first incapacitated by such disease?(d) What was the nature of his employment and for what period was he engaged thereon?(e) If he ever previously suffered from such disease, state:—(i) The approximate date on which it first manifested itself.(ii) The extent to which it interfered with his employment. | |
| Was notice of the accident or incapacity served? If so, on whom and on what date? | |
| What is your relationship to the deceased employee? | |
| Were you dependent upon his earnings at the time of his death? If so, state whether you were wholly dependent. | |
| If you were only in part dependent, give full particulars. | |
| Was any other person contributing towards your maintenance at the time of his death, or did you at that time have any other means of support? If so, give full particulars. | |
| Are you in receipt of an Invalid or Old-age Pension? If so, give particulars. |
Form B—continued.
Claim by Dependant of Employee—continued.
<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:19.95pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Questions and requests for information.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Replies.</span></p></td></tr><tr style="height:1pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-left:14.4pt; margin-bottom:6pt; text-indent:-14.4pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Are you receiving or entitled to receive any payment under any law other than the </span><span style="font-family:'Times New Roman', serif; font-style:italic">Commonwealth Employees’ Compensation Act </span><span style="font-family:'Times New Roman', serif">1930 in respect of the death of the aforesaid employee? If so, give particulars.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:6pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-left:14.4pt; margin-bottom:6pt; text-indent:-14.4pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Give the names, addresses, and relationships to the employee of all other persons (except children) known to you, who were dependent upon his earnings at the time of his death.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:6pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-left:14.4pt; margin-bottom:6pt; text-indent:-14.4pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">If this claim is made more than six months after the accident or incapacity, give reasons for failure to make the claim within that period.</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:6pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-left:14.4pt; margin-bottom:6pt; text-indent:-14.4pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Have you a claim against the Commonwealth or any person for compensation, or for any payment in respect of the injury under any other law in force in the Commonwealth or any other place?</span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:6pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:17.25pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:66.75pt"><td style="width:28.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Full names of children of deceased employee.</span></p></td><td style="width:13.88%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">Dates of Birth.</span></p></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">State whether wholly dependent on earnings of employee at time of his death.</span></p></td><td style="width:28.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">If not wholly dependent, give full particulars.</span></p></td></tr><tr style="height:71.25pt"><td style="width:28.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:13.88%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:28.62%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:0pt"><td style="width:129.15pt"></td><td style="width:63.2pt"></td><td style="width:81.55pt"></td><td style="width:51.2pt"></td><td style="width:130.35pt"></td></tr></tbody></table>
Declared at...............on the..............day of....................19 .
Signature of Declarant....................
Before me †............................
‡............................
* The claim should be addressed to the Permanent Head or Chief Officer of the Department or Authority in or by which the employee was employed at the time of the accident, or to the officer in charge of the work on which the employee was so employed.
† The person before whom this declaration is made to sign here and add the title by which he takes the declaration, such as “Postmaster,” &c.
‡ The declaration may be made before any of the following persons:—
A postmaster or postmistress, or person in charge of a post office, a police stipendiary or special magistrate of the Commonwealth or of a State, a justice of the peace, a barrister or solicitor, a State school head teacher, a member of the police force of the Commonwealth or of a State, a legally qualified medical practitioner, a notary public, a commissioner for affidavits, a commissioner for declarations, a minister of religion, a member of the Parliament of the Commonwealth or of a State, or a councillor or alderman of any municipality or shire.
Form C.
[Front of Form.]
Commonwealth of Australia.
——
Commonwealth Employees’ Compensation Act 1930.
——
REPORT OF MEDICAL REFEREE, MEDICAL BOARD, OR MEDICAL PRACTITIONER.
*I/We............................................................................,*Medical Referee/Medical Board/Medical Practitioner under the Commonwealth Employees’ Compensation Act, have this day examined ..........................................................of.................................................., a claimant for compensation under the above-named Act. On examination—
*I/We find that claimant is suffering from (a)......................................
The above condition is the result of (b) ..........................................., and is such that the claimant is thereby incapacitated at present to the extent of % of total incapacity at his usual occupation, and % of total incapacity in the general labour market. Claimant is fit to undertake employment in such occupations as....................................................................................................................... ............................................................................................................
(c) The above condition is the result of................................................, an industrial disease mentioned in the first column of the Second Schedule to the above-named Act. Such disease * was/was not caused within twelve months prior to the date of claimant’s becoming incapacitated by his employment by the Commonwealth in the process of......................................................................
In *my/our opinion claimant *has/ has not previously suffered from the above-mentioned industrial disease. The disease is/is not of such a nature as is contracted by a gradual process.
General Remarks—
.................................
*Medical Referee.
Medical Board.
Medical Practitioner.
Date.................., 19 .
* Strike out what is inapplicable.
(a) Fully describe claimant’s general condition.
(b) State whether accident or industrial disease.
(c) This part to be filled in only in case of claimant suffering from an industrial disease.
Attention is invited to the provisions of the Second and Third Schedules to the Act, copies of which are shown on the back of this form.
Form C.
[Back of Form.]
THE SECOND SCHEDULE. Section 10.
<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:15.45pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><a id="_Hlk490745430"><span style="font-family:'Times New Roman', serif">Description of Disease.</span></a></p></td><td style="width:58.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Description of Process.</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Arsenic, phosphorus, lead, mercury or other mineral poisoning</span></p></td><td style="width:58.5%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:6pt; margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any employment involving the use or handling of arsenic, phosphorus, lead, mercury or other mineral, or their preparations or compounds</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Anthrax</span><span style="width:147.23pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">........................</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Woolcombing, woolsorting; handling of hides, skins, wool, hair, bristles or carcasses</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Zymotic diseases</span><span style="width:110.85pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..................</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Persons employed in a hospital or quarantine station, or in an ambulance brigade</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Poisoning by benzol or its homologues or their nitro and amido derivatives (dinitro-benzol, anilin and others)</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any process involving the use of benzol or its homologues or their nitro and amido derivatives or their preparations or compounds</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Poisoning by carbon bisulphide</span><span style="width:53.62pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">........</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any process involving the use of carbon bisulphide or its preparations or compounds</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Poisoning by nitrous fumes</span><span style="width:70.27pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...........</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any process in which nitrous fumes are evolved</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Poisoning by cyanogen compounds</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any process in which cyanogen compounds are used</span></p></td></tr><tr style="height:25.3pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Poisoning by carbon monoxide</span><span style="width:55.29pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.........</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any process in which carbon monoxide is used or evolved</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Chrome ulceration</span><span style="width:105.3pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.................</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any process involving the use of chromic acid, or bichromate of ammonium, potassium or sodium or their preparations</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Dermatitis produced by dust or caustic or corrosive liquids or ulceration of the mucous membranes of the nose or month produced by dust</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any industrial process</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Ankylostomiasis</span><span style="width:112.77pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..................</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Any employment involving exposure to hookworm infestation</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Pneumoconiosis</span><span style="width:109.94pt; font-family:'Lucida Console', monospace; display:inline-block">..................</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Quarrying or stone crushing or cutting</span></p></td></tr><tr style="height:1pt"><td style="width:37%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="height:0pt; text-align:left; display:block; position:relative; z-index:0"><img src="image.003.png" width="21" height="142" alt="" style="margin-top:1.23pt; margin-left:164.82pt; position:absolute"></span><span style="font-family:'Times New Roman', serif">Nystagmus</span><span style="width:112.25pt; font-family:'Lucida Console', monospace; display:inline-block">..................</span></p></td><td rowspan="4" style="width:4.5%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:37%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Subcutaneous cellulitis of the hand (beat hand)</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:37%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Subcutaneous cellulitis over the patella (miner’s beat knee)</span></p><p style="margin-left:7.2pt; margin-bottom:0pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Acute bursitis over the elbow (miner’s beat elbow)</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:15pt; margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Mining, or quarrying, or stone crushing or cutting</span></p></td></tr><tr style="height:1pt"><td style="width:37%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:7.2pt; margin-bottom:6pt; text-indent:-7.2pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Inflammation of the synovial lining of the wrist joint and tendon sheath</span></p></td><td style="width:58.5%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
THE THIRD SCHEDULE Section 12.
——
Compensation for Specified Injuries.
<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:86.62%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Nature of Injury.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Amount Payable.</span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.96%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-style:italic">£</span></p></td><td style="width:4.12%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-style:italic">s.</span></p></td><td style="width:2.3%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-style:italic">d.</span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="height:0pt; display:block; position:relative; z-index:1"><img src="image.004.png" width="11" height="88" alt="" style="margin-top:0.43pt; margin-left:373.77pt; position:absolute"></span><span style="font-family:'Times New Roman', serif">Loss of both eyes</span><span style="width:289.73pt; font-family:'Lucida Console', monospace; display:inline-block">................................................</span></p></td><td style="width:6.96%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.12%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.3%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Loss of both hands</span><span style="width:284.17pt; font-family:'Lucida Console', monospace; display:inline-block">...............................................</span></p></td><td style="width:6.96%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.12%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.3%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Loss of both feet</span><span style="width:292.51pt; font-family:'Lucida Console', monospace; display:inline-block">................................................</span></p></td><td rowspan="2" style="width:6.96%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:6pt; margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">750</span></p></td><td rowspan="2" style="width:4.12%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">0</span></p></td><td rowspan="2" style="width:2.3%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Loss of a hand and a foot</span><span style="width:258.92pt; font-family:'Lucida Console', monospace; display:inline-block">..........................................</span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Total and incurable loss of mental powers, involving inability to work</span></p></td><td style="width:6.96%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.12%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.3%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Total and incurable paralysis of limbs or mental powers</span><span style="width:136.73pt; font-family:'Lucida Console', monospace; display:inline-block">......................</span></p></td><td style="width:6.96%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.12%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:2.3%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Loss of either arm, or of the greater part thereof</span><span style="width:185.32pt; font-family:'Lucida Console', monospace; display:inline-block">..............................</span></p></td><td style="width:6.96%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">675</span></p></td><td style="width:4.12%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.3%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Loss of lower part of either arm, either hand, or five fingers of either hand</span></p></td><td style="width:6.96%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">600</span></p></td><td style="width:4.12%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.3%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.62%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Loss of leg</span><span style="width:331.91pt; font-family:'Lucida Console', monospace; display:inline-block">.......................................................</span></p></td><td style="width:6.96%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">600</span></p></td><td style="width:4.12%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.3%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr></tbody></table>
The Third Schedule—continued.
<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:86.26%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">N</span><span style="font-family:'Times New Roman', serif; font-size:10pt">ature of Injury.</span></p></td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Amount Payable.</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.4%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:4.66%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif; font-style:italic">s.</span></p></td><td style="width:2.68%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:6pt; margin-bottom:0pt; text-align:center; line-height:normal"><span style="font-family:'Times New Roman', serif; font-style:italic">d.</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of the lower part of a leg</span><span style="width:246.29pt; font-family:'Lucida Console', monospace; display:inline-block">.....................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">562</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">10</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of a foot</span><span style="width:317.75pt; font-family:'Lucida Console', monospace; display:inline-block">...............................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">525</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of one eye, with serious diminution of the sight of the other</span><span style="width:93.51pt; font-family:'Lucida Console', monospace; display:inline-block">..............</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">675</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of sight of one eye*</span><span style="width:267.65pt; font-family:'Lucida Console', monospace; display:inline-block">........................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">375</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of hearing</span><span style="width:310.12pt; font-family:'Lucida Console', monospace; display:inline-block">..............................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">600</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Complete deafness of one ear</span><span style="width:248.44pt; font-family:'Lucida Console', monospace; display:inline-block">.....................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">200</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of a thumb</span><span style="width:307.36pt; font-family:'Lucida Console', monospace; display:inline-block">..............................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">225</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of a forefinger</span><span style="width:291.5pt; font-family:'Lucida Console', monospace; display:inline-block">...........................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">150</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of part of a thumb</span><span style="width:275.6pt; font-family:'Lucida Console', monospace; display:inline-block">.........................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">112</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">10</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of little finger, middle finger or ring finger</span><span style="width:167.47pt; font-family:'Lucida Console', monospace; display:inline-block">.........................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">112</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">10</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of a toe or the joint of a finger</span><span style="width:222.46pt; font-family:'Lucida Console', monospace; display:inline-block">.................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">90</span></p></td><td style="width:4.66%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr><tr style="height:1pt"><td style="width:86.26%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:6pt; line-height:normal"><span style="font-family:'Times New Roman', serif">Loss of a joint of a toe</span><span style="width:279.57pt; font-family:'Lucida Console', monospace; display:inline-block">..........................................</span></p></td><td style="width:6.4%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"><p style="margin-right:3.6pt; margin-bottom:6pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">75</span></p></td><td style="width:4.66%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:6pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td><td style="width:2.68%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:7.2pt; margin-bottom:6pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">0</span></p></td></tr></tbody></table>
* For the partial loss of the sight of one eye, there shall be payable such percentage of the amount that would be payable for the total loss of the sight thereof as is equal to the percentage of the diminution of sight.
For the purposes of this Schedule, the loss of a specified part of the body shall be deemed to include—
(a) the loss of the use of that part; and
(b) the loss of the efficient use of that part in and for the purposes of his employment:
Provided that in that case a percentage of the prescribed amount payable, equal to the percentage of the diminution of the full efficient use as aforesaid, may be awarded in lieu of the full amount.
Form D.
Commonwealth Employees’ Compensation Act 1930.
——
RETURN OF PAYMENTS MADE DURING THE YEAR ENDED 30th JUNE, 19
Department or Authority................. State.................
<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td colspan="2" style="border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.7%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:4.26%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-style:italic">s.</span></p></td><td style="width:3.64%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:center; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-style:italic">d.</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">1. Amount paid under First Schedule (General)—</span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:64.8pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">) in cases of incapacity</span><span style="width:180.84pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..............................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:73.56%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:64.8pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">) in cases of death</span><span style="width:200.28pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.................................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:12.84%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:73.56%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:50.4pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.84%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">2. </span><span style="font-family:'Times New Roman', serif">Amount paid under Second Schedule (Industrial Diseases)—</span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:64.8pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">a</span><span style="font-family:'Times New Roman', serif">) in cases of incapacity</span><span style="width:180.84pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..............................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:73.56%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:64.8pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(</span><span style="font-family:'Times New Roman', serif; font-style:italic">b</span><span style="font-family:'Times New Roman', serif">) in cases of death</span><span style="width:200.28pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.................................</span><span style="font-family:'Times New Roman', serif">£</span></p></td><td style="width:12.84%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td style="width:73.56%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:50.4pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.84%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">3. </span><span style="font-family:'Times New Roman', serif">Amount paid under Third Schedule (Specified Injuries)—</span></p></td><td style="width:5.7%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-top:3pt; margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif; font-variant:small-caps">4. </span><span style="font-family:'Times New Roman', serif">Amount paid in respect of medical hospital and funeral expenses.</span></p><p style="margin-bottom:3pt; text-indent:28.8pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">(The amount here given should </span><span style="font-family:'Times New Roman', serif; font-style:italic">not </span><span style="font-family:'Times New Roman', serif">be included under (1), (2), or (3).)</span></p></td><td style="width:5.7%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-indent:36pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Total amount of compensation paid under the Act during the year—</span></p></td><td style="width:5.7%; border-top:0.75pt solid #000000; border-bottom:4.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; border-top:0.75pt solid #000000; border-bottom:4.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; border-top:0.75pt solid #000000; border-bottom:4.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-left:57.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Number of injuries in respect of which compensation has been paid under the Act during the year. (The number here given should </span><span style="font-family:'Times New Roman', serif; font-style:italic">not </span><span style="font-family:'Times New Roman', serif">include any injury in respect of which an amount of payment has been included in a previous return)</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.7%; border-top:4.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; border-top:4.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; border-top:4.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:5.7%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:12.65pt"><td colspan="5" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="width:180pt; font-family:'Lucida Console', monospace; display:inline-block">.............................</span></p><p style="margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Permanent Head or Chief Officer of the</span></p><p style="margin-right:21.6pt; margin-bottom:0pt; text-align:right; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">the Department or Authority.</span></p></td></tr><tr style="height:1pt"><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-indent:14.4pt; text-align:justify; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif">Date</span><span style="width:142.22pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.......................</span></p></td><td style="width:5.7%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:4.26%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:3.64%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; line-height:normal; font-size:10pt"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
Note.—Payments made under the Arbitration Determinations or under any other Act should not be included in this return.
Form E.
Commonwealth Employees’ Compensation Act 1930.
——
ELECTION UNDER SECTION 15.
I, ........................................................of...................................................., being a person entitled under the provisions of a determination made by the Public Service Arbitrator appointed under the Arbitration (Public Service) Act 1920-1929 to a grant of compensation or other benefits in respect of personal injury by accident arising out of and in the course of my employment, hereby elect to take compensation or benefits under the Commonwealth Employees’ Compensation Act 1930.
...................
(Signature.)
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(Date.)
By Authority: H. J. Green, Government Printer, Canberra.