Costs. Paragraph (6), Second Schedule, Act. Cf. Eng. r. 61. Vic. r. 58.
(1) Any costs of and incident to an arbitration and proceedings connected therewith directed to be paid by one party to another shall, in default of agreement between the parties as to the amount of such costs, be taxed according to such one of the scales of costs for the time being applicable to actions in the County Court as the committee, arbitrator, or the judge directs, and in default of such direction shall be taxed according to the scale which would be applicable if the proceeding had been an action in the County Court, and the statutory provisions and rules for the time being in force as to the allowance and taxation costs on such actions, and as to objections and review of taxation by the Registrar shall, so far as applicable, apply accordingly.
(2) The costs, whether before a committee or an arbitrator or in the County Court, shall not exceed the limit prescribed by rules of court and shall, subject to these regulations, be taxed in the manner prescribed by those rules.
How amount for purposes of taxation to be determined, &c. Eng. r. 61 (2).
(1) Where the subject-matter of an arbitration is not a capital sum, the committee, arbitrator or the judge shall determine what, for the purpose of the allowance and taxation of costs, shall be considered to be the amount of the subject-matter of the arbitration; and in default of such determination the amount shall be fixed by the Registrar by whom the costs are to be taxed.
Reasonable costs may be allowed where provision not expressed. Eng. (2a) of r. 61
(2) Where proceedings are taken for which no provision is made by these Regulations or by the scale of costs, reasonable costs may be allowed in respect of such proceedings by the Registrar, or by special order of the judge.
Ib. (3).
(3) The committee, arbitrator, or the judge in dealing with the question of costs may take into consideration any offer of compensation proved to have been made on behalf of the employer.
Ib. (4).
(4) Where any seaman is examined by a medical referee on a reference under paragraph (13) of the First Schedule to the Act, and the certificate of the referee is used in any subsequent arbitration, any reasonable travelling and other expenses incurred by the seamen in obtaining the certificate (if not otherwise provided for) may, by order of the committee, arbitrator, or the judge, be allowed as costs in the arbitration.
Ib. (5).
(5) Where a seaman is ordered to submit himself for examination by a medical referee appointed to report under paragraph (12) of the Second Schedule to the Act, any reasonable expenses incurred by the seaman in travelling to attend on the referee for examination may by order of the committee, arbitrator, or the judge be allowed as costs in the arbitration.
<table cellspacing="0" cellpadding="0" style="margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">1. Name and address of applicant</span><span style="width:141.39pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.....................</span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">2. Name of ship on which applicant was employed at time of accident and port of registry</span><span style="width:1.64pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">3. Nature of employment at time of accident</span><span style="width:93.13pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..............</span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">4. Date and place of accident, nature of work on</span><span style="width:76.34pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...........</span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">which applicant was then engaged, and nature of accident and cause of injury</span><span style="width:33.44pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">5. Nature of injury</span><span style="width:206.13pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...............................</span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">6. Particulars of incapacity for work, whether</span><span style="width:88.24pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.............</span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span><span style="font-family:'Times New Roman', serif">total or partial, and estimated duration of incapacity</span><span style="width:40.89pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">......</span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td rowspan="2" style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">7. Average weekly earnings during the 12 months previous to the injury, if the applicant has been so long employed under the same owners or charterers, or if not, during any less period during which he has been so employed</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:37.95pt"><td style="width:260.1pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">8. Average weekly amount which the applicant is earning or is able to earn in some suitable employment or business after the accident</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:180.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:26.2pt"><td style="width:318.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">9. Payment allowance or benefit received from employer during the period of incapacity</span><span style="width:7.18pt; text-indent:0pt; display:inline-block"></span></p></td><td rowspan="2" style="width:122.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:11.45pt"><td style="width:318.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">10. Amount claimed as compensation</span><span style="width:122.12pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..................</span></p></td></tr><tr><td style="width:318.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">11. Date of service of statutory notice of accident, and whether given before applicant voluntarily left the employment in which he was injured. [</span><span style="font-family:'Times New Roman', serif; font-style:italic">A copy of the notice to be annexed</span><span style="font-family:'Times New Roman', serif">]</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:122.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:318.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">12. If notice not served, reason for omission to serve same</span><span style="width:31.4pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">....</span></p></td><td style="width:122.05pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">1. Name and late address of seaman</span><span style="width:101.29pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...............</span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">2. Name of ship of which deceased was employed at time of accident or loss of ship and port of registry</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">3. Nature of employment at time of accident or loss of ship</span><span style="width:28.35pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">4. Date and place of accident, nature of work on which deceased was then engaged, and nature of accident and cause of injury [</span><span style="font-family:'Times New Roman', serif; font-style:italic">or</span><span style="font-family:'Times New Roman', serif"> date and place when and where ship was lost or is deemed to have been lost]</span></p><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">5. Nature of injury to deceased and date of death [</span><span style="font-family:'Times New Roman', serif; font-style:italic">or</span><span style="font-family:'Times New Roman', serif"> date when ship was lost or is deemed to have been lost</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">6. Earnings of deceased during the 3 years next preceding the injury or date of loss if he had been so long employed under the same owners [</span><span style="font-family:'Times New Roman', serif; font-style:italic">or</span><span style="font-family:'Times New Roman', serif"> charterers], or if the period of his employment had been less than the said 3 years, particulars of his average weekly earnings during the period of actual employment under the said owners [</span><span style="font-family:'Times New Roman', serif; font-style:italic">or</span><span style="font-family:'Times New Roman', serif"> charterers]</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">7. Amount of weekly payments [if any] made to deceased under the Act, and of any lump sum paid in redemption thereof</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">8. Name and address of applicant for arbitration</span><span style="width:48.44pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">.......</span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td rowspan="2" style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">9. Character in which applicant applies for </span><span style="width:17.9pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">..</span><span style="font-family:'Times New Roman', serif">arbitration, </span><span style="font-family:'Times New Roman', serif; font-style:italic">i.e</span><span style="font-family:'Times New Roman', serif">., whether as legal personal representative of deceased, or as a dependant and if as a dependant, particulars showing how he is so</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:273.6pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">10. Particulars as to the dependants of the deceased by whom or on whose behalf the application is made, giving their names and addresses, and descriptions and occupations [if any] and their relationship to the deceased, and if infants, their respective ages, and stating whether they were wholly or partially dependent on the earnings of the deceased at the time of his death</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:167.05pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">1. Name and late address of deceased seaman</span><span style="width:73.25pt; text-indent:0pt; font-family:'Lucida Console', monospace; display:inline-block">...........</span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">2. Name of ship on which deceased was employed at time of accident or loss of ship and port of registry</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">3. Nature of injury to deceased and date of death [</span><span style="font-family:'Times New Roman', serif; font-style:italic">or</span><span style="font-family:'Times New Roman', serif"> date when ship lost or is deemed to have been lost]</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">4. Agreed or ascertained amount of compensation to be paid to dependants of deceased</span><span style="width:12.97pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">5. Particulars as to whether the compensation money is still payable by the employer or has been paid by him, and if so, to whom, and in whose hands it now is</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">6. Character in which the applicant applies for arbitration, </span><span style="font-family:'Times New Roman', serif; font-style:italic">i.e</span><span style="font-family:'Times New Roman', serif">., whether as legal personal representative of deceased or as a dependant, and if as a dependant, particulars showing how he is so</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td rowspan="2" style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">7. Particulars as to the dependants or persons claiming to be dependants by whom or on whose behalf the application is made, giving the names and addresses and descriptions and occupations (if any) and their relationship to the deceased, and if infants, their respective ages, and stating whether they were or claim to have been wholly or partially dependent on the earnings of the deceased at the time of his death.</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">8. The like particulars as to any dependants who are made respondents</span><span style="width:10.91pt; text-indent:0pt; display:inline-block"></span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:27.35pt; margin-bottom:0pt; text-indent:21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">[Note.—</span><span style="font-family:'Times New Roman', serif; font-style:italic">If there is a legal personal representative, and he is not an applicant, he must be made a respondent</span><span style="font-family:'Times New Roman', serif">.]</span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">9. Particulars as to any persons claiming or who may be entitled to claim to be dependants, but as to whose claim a question arises, and who are therefore made respondents, with their names, addresses, descriptions, and occupations (if any)</span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr><td style="width:287.1pt; border-right:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top"><p style="margin-left:21.6pt; margin-bottom:0pt; text-indent:-21.6pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">10. Particulars of the manner in which the applicant claims to have the amount of compensation apportioned and applied</span><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:153.55pt; border-left:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr style="height:1pt"><td rowspan="2" style="width:13.3pt; height:1pt; margin-left:auto; writing-mode:tb-rl; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Number of matter.</span></p></div></td><td rowspan="2" style="width:13.3pt; height:1pt; margin-left:auto; writing-mode:tb-rl; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Names of Parties.</span></p></div></td><td rowspan="2" style="width:13.3pt; height:1pt; margin-left:auto; writing-mode:tb-rl; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Date on which Reference received.</span></p></div></td><td rowspan="2" style="width:13.3pt; height:1pt; margin-left:auto; writing-mode:tb-rl; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">From whom received.</span></p></div></td><td rowspan="2" style="width:13.3pt; height:1pt; margin-left:auto; writing-mode:tb-rl; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Date of Examination.</span></p></div></td><td rowspan="2" style="width:13.3pt; height:1pt; margin-left:auto; writing-mode:tb-rl; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Place of Examination.</span></p></div></td><td rowspan="2" style="width:26.9pt; height:1pt; margin-left:auto; writing-mode:tb-rl; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Date on which Certificate or Report sent.</span></p></div></td><td rowspan="2" style="width:17.25pt; height:1pt; margin-left:auto; writing-mode:tb-rl; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top; -moz-transform:rotate(180deg); -ms-transform:rotate(180deg); overflow:hidden; transform:rotate(180deg); -webkit-transform:rotate(180deg)"><div style="height:1pt; margin-left:auto; writing-mode:tb-rl; overflow:hidden"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Tenor of Certificate.</span></p></div></td><td colspan="4" style="width:238.35pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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">Amount of Fees under each of the Headings in Regulation 95.</span></p></td><td rowspan="2" style="width:51.15pt; border-left:0.75pt solid #000000; border-bottom: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">Expert Assistance.</span></p></td></tr><tr style="height:1pt"><td style="width:46.45pt; 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">First Reference; Examination and Certificate or Report.</span></p></td><td style="width:65.3pt; 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">Subsequent Reference; Examination and Certificate or Report.</span></p></td><td style="width:45.45pt; 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">Further Statement</span></p></td><td style="width:69.15pt; 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">Travelling more than two miles from residence [</span><span style="font-family:'Times New Roman', serif; font-style:italic">or</span><span style="font-family:'Times New Roman', serif"> centre] to examine Seaman. (</span><span style="font-family:'Times New Roman', serif; font-style:italic">See</span><span style="font-family:'Times New Roman', serif"> Certificate of Distance and Scale of Fees on back.)</span></p></td></tr><tr style="height:1pt"><td style="width:13.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom: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"></span></p></td><td style="width:13.3pt; 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"></span></p></td><td style="width:13.3pt; 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"></span></p></td><td style="width:13.3pt; 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"></span></p></td><td style="width:13.3pt; 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"></span></p></td><td style="width:13.3pt; 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"></span></p></td><td style="width:26.9pt; 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"></span></p></td><td style="width:17.25pt; 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"></span></p></td><td style="width:46.45pt; 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">£ </span><span style="font-family:'Times New Roman', serif; font-style:italic">s</span><span style="font-family:'Times New Roman', serif">. </span><span style="font-family:'Times New Roman', serif; font-style:italic">d</span><span style="font-family:'Times New Roman', serif">.</span></p></td><td style="width:65.3pt; 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">£ </span><span style="font-family:'Times New Roman', serif; font-style:italic">s</span><span style="font-family:'Times New Roman', serif">. </span><span style="font-family:'Times New Roman', serif; font-style:italic">d</span><span style="font-family:'Times New Roman', serif">.</span></p></td><td style="width:45.45pt; 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">£ </span><span style="font-family:'Times New Roman', serif; font-style:italic">s</span><span style="font-family:'Times New Roman', serif">. </span><span style="font-family:'Times New Roman', serif; font-style:italic">d</span><span style="font-family:'Times New Roman', serif">.</span></p></td><td style="width:69.15pt; 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">£ </span><span style="font-family:'Times New Roman', serif; font-style:italic">s</span><span style="font-family:'Times New Roman', serif">. </span><span style="font-family:'Times New Roman', serif; font-style:italic">d</span><span style="font-family:'Times New Roman', serif">.</span></p></td><td style="width:51.15pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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">£ </span><span style="font-family:'Times New Roman', serif; font-style:italic">s</span><span style="font-family:'Times New Roman', serif">. </span><span style="font-family:'Times New Roman', serif; font-style:italic">d</span><span style="font-family:'Times New Roman', serif">.</span></p></td></tr><tr style="height:70.8pt"><td colspan="8" style="width:151.95pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom: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"></span></p></td><td style="width:46.45pt; 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"></span></p></td><td style="width:65.3pt; 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"></span></p></td><td style="width:45.45pt; 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"></span></p></td><td style="width:69.15pt; 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"></span></p></td><td style="width:51.15pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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"></span></p></td></tr><tr style="height:17.25pt"><td colspan="8" style="width:151.95pt; border-top:0.75pt solid #000000; border-right: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">Totals</span><span style="width:80.51pt; font-family:'Lucida Console', monospace; display:inline-block">............</span></p></td><td style="width:46.45pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left: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"></span></p></td><td style="width:65.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left: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"></span></p></td><td style="width:45.45pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left: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"></span></p></td><td style="width:69.15pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left: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"></span></p></td><td style="width:51.15pt; border-top:0.75pt solid #000000; border-left: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"></span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border-collapse:collapse"><tbody><tr style="height:1pt"><td style="width:8.9%; 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">Number of Matter.</span></p></td><td style="width:9.18%; 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">Name of Seaman.</span></p></td><td style="width:11.68%; 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">Date on which Reference Received.</span></p></td><td style="width:10.62%; 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">From Whom Received.</span></p></td><td style="width:14.2%; 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">Date of Examination.</span></p></td><td style="width:11.7%; 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">Date on which Certificate sent to Registrar.</span></p></td><td style="width:11.82%; 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">Whether Incapacity Certified to be Permanent or not.</span></p></td><td style="width:9.74%; 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">Fees. (per case to include all Duties).</span></p></td><td style="width:12.14%; 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">Expert Assistance.</span></p></td></tr><tr style="height:57.75pt"><td style="width:8.9%; 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:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.18%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.68%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.62%; 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; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.2%; 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:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.74%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">£ </span><span style="font-family:'Times New Roman', serif; font-style:italic">s</span><span style="font-family:'Times New Roman', serif">. </span><span style="font-family:'Times New Roman', serif; font-style:italic">d</span><span style="font-family:'Times New Roman', serif">.</span></p></td><td style="width:12.14%; 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:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">£ </span><span style="font-family:'Times New Roman', serif; font-style:italic">s</span><span style="font-family:'Times New Roman', serif">. </span><span style="font-family:'Times New Roman', serif; font-style:italic">d</span><span style="font-family:'Times New Roman', serif">.</span></p></td></tr><tr style="height:1pt"><td style="width:8.9%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.18%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.68%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.62%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:14.2%; border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><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-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif">Totals …….</span></p></td><td style="width:9.74%; 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:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:12.14%; 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:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr><tr style="height:1pt"><td colspan="9" style="padding-right:2pt; padding-left:2pt; vertical-align:top"><p style="margin-right:32.95pt; margin-bottom:0pt; text-align:right; line-height:normal"><span style="font-family:'Times New Roman', serif">Total £</span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="width:100%; margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr style="height:1pt"><td rowspan="2" style="width:8.04%; border-right:0.75pt solid #000000; border-bottom: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">Number.</span></p></td><td rowspan="2" style="width:6.92%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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">Name of Parties.</span></p></td><td rowspan="2" style="width:9.12%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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">Date on which Reference Received.</span></p></td><td rowspan="2" style="width:8.94%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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">Registrar from Whom Received.</span></p></td><td rowspan="2" style="width:11.78%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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">Date and Place of Examination.</span></p></td><td rowspan="2" style="width:6.4%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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">Date on which Report Sent.</span></p></td><td colspan="4" style="border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom: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">Amount of Fees under—</span></p></td><td rowspan="2" style="width:10.08%; border-left:0.75pt solid #000000; border-bottom: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">Expert Assistance.</span></p></td></tr><tr style="height:1pt"><td style="width:9.62%; 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">First Reference.</span></p></td><td style="width:10.24%; 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">Subsequent Reference.</span></p></td><td style="width:9.5%; 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">Further Statement.</span></p></td><td style="width:9.34%; 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">Travelling Expenses.</span></p></td></tr><tr style="height:73.05pt"><td style="width:8.04%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:6.92%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.12%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:8.94%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:11.78%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.24%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.5%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:9.34%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td><td style="width:10.08%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"><p style="margin-bottom:0pt; text-align:justify; line-height:normal"><span style="font-family:'Times New Roman', serif"></span></p></td></tr></tbody></table>
```
Taxation of costs awarded by committee or arbitrator agreed on by the parties. Cf Eng. r. 62.
(1) Where any costs are awarded by a committee or arbitrator agreed on by the parties, an application by any party interested may be made to the Registrar of a County Court for the taxation of the costs so awarded.
(2) Upon the receipt of the application, the Registrar shall fix a time for the hearing of the application, not being less than seven days from the date of the application.
(3) Upon the time for the hearing of the application being fixed, the Registrar shall send a notice thereof to the parties to the arbitration.
(4) On the day fixed for the healing the Registrar shall dispose of the application on hearing the parties or such of them as are present at the hearing.
(5) On the costs being taxed the Registrar shall notify the prescribed authority, with whom the memorandum of the decision of the committee or arbitrator has been recorded, of the amount of costs allowed on the taxation.
(6) The prescribed authority shall enter the amount of costs allowed on the taxation in the register, and the entry shall be deemed to be part of the memorandum recorded with the prescribed authority, and shall be enforced accordingly.
Execution. Eng. r. 67. Vic. r. 68.
(1) When a party liable to pay compensation or costs under any award or memorandum has made default in payment of the amount awarded, or where payment is to be made by instalments, of any instalment, execution may issue against his goods without leave for the amount in payment of which he has made default.
(2) The party applying for execution shall satisfy the Registrar by affidavit or otherwise, as to the amount in payment of which default has been made.
(3) Where the parties liable to pay compensation or costs under any award or memorandum are a firm, an execution under this rule may issue in manner following:—
(a) Against any property of the partnership;
(b) Against any property of any person who has admitted in the proceedings that he was a partner at the time of the accruing of the cause of complaint, or who has been adjudged to be liable as a partner;
(c) Against any property of any person who was individually served as a partner or a person sought to be made liable and who failed to appear at the arbitration.
(4) If the party who has obtained the judgment or order claims to be entitled to issue execution against the property of any other person as a member of the firm, he may, after giving to the person two clear days' notice of his intention, apply to the judge for leave so to do; and the judge may give the leave if the liability is not disputed, or if the liability is disputed, may try and determine the question.
(5) Except as against any property of the partnership, an award against a firm shall not render liable, release, or otherwise affect any member thereof who was out of Australia when the proceedings were commenced, unless he has been made a party or has been served within Australia after proceedings commenced.
Proceedings on judgment summons. Eng. r. 68. Vic. r. 68.
(1) Where proceedings by way of judgment summons are taken against a party liable to pay compensation or costs under any award or memorandum, who has made default in payment of the amount awarded, or (where payment is to be made by instalments) of any instalment, the County Court Rules for the time being in force as to the committal of judgment debtors shall, with any necessary modifications, apply to such proceedings:
Provided that the court shall not alter the terms or mode of payment of any sum to become payable in future under any award or memorandum otherwise than by consent.
(2) The party applying for a judgment summons shall satisfy court, by affidavit or otherwise, as to the amount in payment of which default has been made.
(3) A judgment summons issued under this regulation shall be in accordance with Form 55 in the Schedule.
(4)Where the parties liable to pay compensation or costs are a firm, the provisions of the County Court Rules for the time being as to judgment summonses on a judgment or order against a firm shall, with the necessary modifications, apply to proceedings by way of judgment summons under this regulation.
Other proceedings for enforcement of award, &c. Eng. r. 69.
The County Court Rules for the time being in force as to proceedings for the enforcement of or the recovery of money due under judgments or orders of the County Court otherwise than by execution or committal shall, with the necessary modifications, apply to proceedings for the enforcement of or the recovery of money due under any award or memorandum.
When award or order may be set aside or varied. Eng. r. 70
(1) Where the judge is satisfied—
(a) that any award, or any order as to the application of any amount awarded or agreed upon as compensation made by the judge or an arbitrator appointed by him, has been obtained by fraud or other improper means; or
(b) that any person has been included in any award or order as a dependant who is not in fact a dependant; or
(c) that any person who is in fact a dependant has been omitted from any award or order,
the judge may set aside or vary the award or order, and may make such order (including an order as to any sum already paid under the award or order) as under the circumstances he thinks just.
(2) An application to set aside or vary an award or order under this regulation shall be made on notice in writing, and the provisions of regulation 50 shall apply to the proceedings on such application.
(3) An application to set aside or vary an award or order under this regulation shall not be made after the expiration of six months from the date of the award or order, except by leave of the judge; and the leave shall not be granted unless the judge is satisfied that the failure to make the application within such period was occasioned by mistake, absence from Australia, or other reasonable cause.
Deposit of order of Court of Appeal with Registrar and procedure thereon. Eng. r. 72.
(1) When the Court of Appeal has given judgment on any appeal, any party may deposit the order of the court of Appeal, or an office copy thereof, with the Registrar, and the Registrar shall file the order or copy and shall transmit a copy thereof to the judge, and the order shall have the same effect as if it had been a decision of the judge.
(2) If the order has the effect of an award, decision, or order in the matter in favour of any party, the order shall be served and recorded and may be proceeded on in the same manner as if it had been an award decision or order of the judge.
(3) If the order be to the effect that an award be made or a decision given or order made in favour of any party, the judge shall make the award or give the decision or make the order accordingly.
(4) If the order directs or involves a rehearing or further hearing of an arbitration or special case or other matter, the judge shall as soon as conveniently may be appoint a day and hour for the rehearing or further hearing, and shall instruct the Registrar to give notice thereof forthwith to the parties.
(5) Generally the judge shall make such award or give such decision or make such order and give such directions and take or direct to be taken such proceedings in the matter, as are necessary to give effect to the order of the Court of Appeal.
Where proceedings may be taken. Eng. r. 73.
(1) All matters which under the Act or these Regulations are required to be done in the County Court, or by, to or before a judge, shall be done in the County Court, or by, to or before a judge holding such County Court—
(i) nearest to the place in which all the parties reside;
(ii) if the parties concerned reside in different places—
(a) nearest to the place in which the accident out of which the matter arose occurred; or
(b) if the accident out of which the matter arose occurred at sea,
(a) nearest to the place in which the ship shall be when the matter is to be done; or
(b) nearest to the port of registry of the ship; or
(c) nearest to the place in which the seaman or the dependants of the seaman by whom or on whose behalf the matter is to be done, or some or one of them, resides or reside;
without prejudice to any transfer in manner provided by these Regulations.
(2) An application for an order for the detention of a ship may be made to the judge of any court.
(3) Where proceedings by way of arbitration for the recovery of compensation are taken against the persons giving security pursuant to section 13 of the Act and regulation 42, the proceedings may be commenced in the County Court—
(i) nearest to the place in which all the parties reside;
(ii) if the parties concerned reside in different places—
(a) nearest to the place in which the accident out of which the matter arose, occurred; or
(b) if the accident occurred at sea—
(a) nearest to the place where the vessel is or was detained, or where the order for detention was made or applied for; or
(b) nearest to the place where the seaman or the dependants of the seaman, or some or one of them, resides or reside;
without prejudice to any transfer in manner provided by these Regulations.
Where any party intends to take the objection that proceedings have been commenced or taken in the wrong place he shall give fourteen clear days' notice of his intention so to do, and the judge, if he upholds such objection, may transfer the proceedings to the proper place upon such terms as he thinks fit.
Variation by a judge other than the judge making the order.
The judge for the time being, holding a court in any district or place, may vary or otherwise deal with any matter or order dealt with or made by any other judge who has held a court in the same district or place, so far as the circumstances of the case will permit.
Filing of certified copy of memorandum, &c., recorded under Second Schedule of Act paragraph (8) before taking subsequent proceedings in a court. Eng. r. 74.
Where an award, or a memorandum under paragraph (8) of the Second Schedule to the Act, has been recorded, and any party desires to take any subsequent proceedings with reference to the subject-matter of such award or memorandum in a court, he shall before taking the proceedings obtain from the prescribed authority a certified copy of the award or memorandum and shall file the same in the court in which he desires to take proceedings.
Transfer. Eng. r. 75.
If the judge is satisfied by any party to any matter under the Act before him that the matter can be more conveniently proceeded with before any other judge as the case may require, he may order the matter to be transferred to the other judge, and thereupon the Registrar shall forthwith transmit by registered post to the Registrar of the County Court at the place-to which the matter is transferred, all original documents filed in the matter, and shall transfer to the last-mentioned court any money invested in his name as Registrar, and thenceforth the matter shall be proceeded with in the court at the place to which it is transferred in the same manner as if it had originally been commenced therein.
Procedure in connexion with application to transfer. (0 viii r. 9, Eng.).
(1) Where application is intended to be made for the transfer under the last preceding regulation, three clear days' notice in writing of such intended application shall be given by the applicant to the Registrar and to all parties who may be affected by the application; but the judge may at any time, by consent of all parties, or without such consent, if he thinks fit, order a transfer although this regulation has not been complied with.
(2) When a transfer is ordered, the judge may make such order as to the costs incurred before or occasioned by such transfer as he thinks fit, and a certified copy of the proceedings shall be transmitted.
(3) The costs of such copy and the costs of transmission shall be paid for in the first instance by the party on whose application the transfer has been made, or if the transfer is made by the judge without any application to transfer being made to him, the costs shall be paid for in the first instance by the applicant; but the payment shall be without prejudice to any question as to the party by whom the costs are ultimately to be borne.
Filing and service of documents and notices. Eng. r. 77.
(1) Where any document is to be filed with the Registrar or the prescribed authority under these Regulations, that document may be so filed by delivering it at the office of the Registrar, or prescribed authority (as the case may be), or by sending it by post addressed to the Registrar or the prescribed authority (as the case may be), at his office.
(2) Where any document is to be so filed, there shall be filed with the original document as many copies of the document as there are persons to whom copies of the document or any part thereof are to be sent by the Registrar or by the prescribed authority, and in addition a copy for the use of the judge.
(3) Where any document is under these Regulations to be sent to any person by the Registrar, or by the prescribed authority, that document may be sent by post.
(4) Any proceeding, document, or notice which is under these Regulations to be served on any party may be served on the party by the opposite party or his solicitor; and where no special provision as to the mode of service is made by these Regulations, the proceeding, document or notice may be served on the party or, where he acts by a solicitor, on his solicitor in manner provided by sub-sections (3), (4), and (5) of section 6 of the Act with reference to service of notice in respect of an injury.
Provisions as to parties acting by barristers and solicitors and as to substituted service and notice in lieu of service. Cf. Eng. r. 78.
The following provisions shall apply to the case of parties acting by solicitors, and as to substituted service and notice in lieu of service—
(a) When a party acts by a solicitor, service of any order in the nature of a decree and of any interlocutory order, or any notice relating to any such order when directed to be served, may be made by or upon the solicitor, as the case may be.
(b) Where by these Regulations any act may be done by any party, the act may be done either in person or by his solicitor or, where it can legally be done by an agent, by an agent.
(c) Where a party acts by a solicitor, any document, notice or proceeding, required to be served by or upon the party, may be served by or upon the solicitor, except in cases where by these Regulations personal service upon a party is required; and service of the document, notice, or proceeding upon the solicitor, or delivery of the same at his office or sending the same to him by post, prepaid, shall be deemed to be good service upon the party for whom the solicitor acts, as upon the day when the same is so served or delivered, or upon which, in the ordinary course of post, it would be delivered: Provided that the provisions of this paragraph shall not extend to any judgment summons.
(d) A solicitor acting for a party in any matter may give notice in writing by post or otherwise to the Registrar and to the other party, or his solicitor, that he is so acting, whereupon service of any document, notice or proceeding whatsoever authorized by these Regulations to be served by or upon a solicitor so acting shall be served by or upon the solicitor accordingly, and he shall be deemed to be the solicitor acting for the party on whose behalf he has given the notice, until notice of change of solicitor has been duly given.
(e) Where a solicitor undertakes the service of any process, he shall make the necessary copies of each process, and the Registrar shall initial the same and return them to the solicitor for service.
(f) Any party who acts by a solicitor may change his solicitor without any order for that purpose, but when any change is made he shall give forty-eight hours’ notice in writing to the Registrar and to the other parties to the proceedings or the solicitors (if any) acting for them of the change and of the name or firm and place of business of the new solicitor, and the Registrar shall file the notice given to him; but until the notice is filed and a copy thereof served, the former solicitor shall be deemed to be the solicitor of the party.
(g) Where by reason of the absence of any party or from any other sufficient cause, the service of any summons (other than a judgment summons), petition, notice, proceeding or document cannot be made, a judge may, upon an affidavit showing grounds, make such order for substituted or other service, or for the substitution for service of notice by advertisement or otherwise, as is just.
Service of documents where Commonwealth a party. Cf. Eng. r. 79.
In any proceedings under the Act or these Regulations, arising out of an injury to a seaman employed by or under the Commonwealth, any proceeding, document, or notice to be served on the Commonwealth may be served on the permanent head of the department in which the seaman is employed subject to the provisions of these Regulations as to service on parties acting by solicitors.
Procedure where not otherwise provided for. Eng. r. 80.
Where any matter or thing is not specially provided for under these Regulations, the same procedure shall be followed and the same provisions shall apply, as far as practicable, as in a similar matter or thing under the Acts relating to County Courts, and the Rules made in pursuance of those Acts, in so far as such procedure and provisions are applicable to proceedings by way of arbitration.
Record of proceedings before judge or magistrates. Special register. Eng. r. 81.
Proceedings under the Act before a judge or arbitrator shall be recorded in the books of the County Court in the place in which proceedings have been commenced, or to which they have been transferred, in the manner in which other proceedings in the County Court are recorded; and the Registrar shall also keep a special register for the purposes of the Act, in which he shall record—
(i) A memorandum of every application made to the judge for the settlement of any matter by arbitration.
(ii) A memorandum of every appointment of an arbitrator to settle any matter made by the judge.
(iii) A memorandum of every proceeding taken in any arbitration before the judge or an arbitrator appointed by him prior to the award.
(iv) A memorandum of every appointment of a medical referee by the judge or arbitrator, and of his report.
(v) A memorandum of every award made by the judge or an arbitrator appointed by him.
(vi) A memorandum of every special case submitted to the judge and of the proceedings and order thereon.
(vii) A memorandum of every judgment given by the Court of Appeal on any appeal.
(viii) A memorandum of every application to the court for the detention of a ship pursuant to section 13 of the Act and regulation 42, and of the order and subsequent proceedings thereon.
(ix) A memorandum of every application to the court for the appointment of an arbitrator in case of the death or refusal or inability to act of an arbitrator agreed on by the parties, and of the proceedings and order thereon.
(x) A copy of every memorandum sent to the prescribed authority pursuant to paragraph (8) of the Second Schedule to the Act, and of the report (if any) of the medical referee annexed thereto, with a note stating whether such memorandum was recorded without further proof, or after inquiry, or by order of the judge.
(xi) If the memorandum is recorded after inquiry, a memorandum of the inquiries made and of the result thereof.
(xii) If the memorandum is recorded by order of the judge, a memorandum of the application to the judge and of the order made thereon.
(xiii) If in the case of a memorandum of an agreement the matter is referred to the judge, a memorandum of the reference and of the directions of the judge and the subsequent proceedings and order thereon.
(xiv) A memorandum of the result of every taxation under any such memorandum, or under any award or order.
(xv) A memorandum of every application to rectify the register in respect of any memorandum, and of the proceedings and order thereon.
(xvi) 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.
(xvii) A memorandum of every proceeding taken for the enforcement of any award, order, memorandum, or certificate and of the result of such proceeding.
(xviii) A memorandum of every application to refer a matter to a medical referee pursuant to paragraph (13) of the First Schedule to the Act, and of the order and subsequent proceedings thereon.
(xix) A memorandum of every application 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.
(xx) A memorandum of every application made with reference to any sum paid to the prescribed authority and of every order made on such application and of the manner in which the sum is invested, applied, or disposed of.
(xxi) A memorandum of every application for variation of an order as to the apportionment, investment, or application of any sum paid as compensation, and of the proceedings and order thereon.
(xxii) A memorandum of every application to set aside or vary an award or order under Regulation and of the proceedings and order thereon.
(xxiii) A memorandum of every certified copy filed pursuant to regulation 75.
(xxiv) A memorandum of every application for transfer, and of the order thereon and the proceedings under the order.
(xxv) A memorandum of the transmission of documents and certified copies under sub-regulation (14) of regulation 42.
(xxvi) A memorandum of the transfer of any money paid into court to any other court.
(xxvii) The like memorandum as to every matter transferred or document or certified copy transmitted or money transferred to a 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.
(xxviii) A memorandum of any other matter which the judge shall order to be recorded with reference to any matter brought into or proceeding taken under the Act.
Part III.—Times for Examination of Seamen by a Medical Practitioner paid by Employer.
Worker meeting with accident not to be required to be medically examined except at reasonable hours.
Where a seaman has given notice of an accident or is in receipt of weekly payments under the Act, he shall not be required to submit himself, against his will, for examination by a medical practitioner provided by the employer except at reasonable hours.
Intervals between examinations of worker in receipt of weekly payments.
A seaman in receipt of weekly payments shall not be required, after a period of one month has elapsed from the date on which the first payment of compensation was made, or if the first payment is made in obedience to the award of a judge or arbitrator, from the date of the award, to submit himself, against his will, for examination by a medical practitioner provided by the employer except at the following intervals:—Once a week during the second, and once a month during the third, fourth, fifth, and sixth months, after the date of the first payment or the award, as the case may be, and thereafter once in every two months:
Additional examination after second month when revision of payments sought.
Provided that where after the second month an application has been made to a judge or arbitrator for a review of the weekly payment, the seaman may be required, pending and for the purposes of the settlement of the application, to submit himself to one additional examination.
Part IV.—Duties and Remuneration of Medical Referees under Provisions of First and Second Schedules of the Act.
Division 1.—General.
In absence of special circumstances reference to be to referee for place in which case arises.
In the case of any reference under these Regulations, the medical referee, in the absence of special circumstances, shall be one of those appointed for the place in which the case arises:
Provided that, where there has been a previous reference in any case, any subsequent reference in the same case shall, if possible, be made to the same referee and be accompanied by the previous report or certificate, or copy thereof, of the medical referee.
Reference to be signed by registrar and have court seal.
The medical referee shall not accept any reference under these Regulations unless signed or countersigned by the Registrar of a County Court and sealed with the seal of the County Court or unless signed by the prescribed authority.
Referee to furnish quarterly statement of fees.
The medical referee shall send to the prescribed authority, at the end of each quarter, statements, in accordance with the forms in the Schedule, of the fees due to him for the quarter under these Regulations.
Statement of travelling expenses with quarterly statement.
In cases where a claim is made under these Regulation in respect of travelling expenses, the medical referee, in submitting his quarterly statements under the last preceding regulation, shall certify the distance of the place to which he was required to travel from his residence or other prescribed centre.
Minister may allow referee special expert assistance.
In cases involving special difficulty the medical referee may apply to the Minister for special expert assistance, which may be granted by the Minister, if he thinks fit, on such terms as to remuneration or otherwise as he thinks fit.
Division 2.—References under Schedule I., Paragraph (13).
Application for reference to a medical referee under paragraph (13) of First Schedule of Act. Eng r. 54.
(1) With respect to applications to the prescribed authority pursuant to paragraph (13) of the First Schedule to the Act to refer any matter to a medical referee the following provisions have effect.
(2) An application to the prescribed authority to refer any matter to a medical referee shall be made in writing, and shall contain a statement of the facts which render the application necessary, in accordance with Form 36 in the Schedule and shall be accompanied by a copy of the report of every medical practitioner who has examined the worker either on behalf of the employer or on the selection of the worker. The application shall be signed by or on behalf of both parties; and the applicant shall file copies of the application and reports for the use of the medical referee.
(3) On the hearing of the application the prescribed authority shall refer the matter to one of the medical referees appointed for the area comprising the place in which the arbitration is pending; and shall forward to the medical referee by registered post one of the filed copies of the application and reports, with an order of reference in accordance with Form 37 in the Schedule.
(4) The prescribed authority shall also make an order directing the seaman to submit himself for examination by the medical referee.
(5) Before making the order the prescribed authority shall inquire whether the seaman is in a fit condition to travel for the purpose of examination, and if satisfied that he is in a fit condition shall by the order direct him to attend at such time and place as the referee determines, and if satisfied that he is not in a fit condition to travel shall so state in the order of reference; and it shall be the duty of the seaman on being served with the order to submit himself for examination accordingly.
(6) The prescribed authority shall deliver or send by registered post to each party a copy of the order of reference, and shall send to the seaman a copy of the order directing him to submit himself for examination, with a notice of the consequence or effect of any refusal or obstruction to the submission for examination.
(7) The medical referee shall forward his certificate in the matter to the prescribed authority by registered post.
(8) On the receipt of the certificate of the medical referee the prescribed authority shall inform the parties by post that it has been received, and shall permit any party to inspect the same during office hours, and shall on the application and at the cost of either party furnish him with a copy of the certificate, or allow him to take a copy thereof.
(9) The fee payable by the applicant for such reference shall be calculated at the rate of One shilling in the pound on twenty-six times the amount of the weekly payments claimed by or payable to the seaman, but so that the total fee shall not exceed Two pounds.
(10) The costs of any application to the prescribed authority, including the fee paid under the last preceding sub-regulation may be allowed as costs in any subsequent proceedings for the settlement of the weekly payment to be made to the seaman, or where the application is made after the weekly payment has been settled, as costs in any subsequent arbitration as to the review of the weekly payment.
On receipt of reference referee to send notice to parties fixing time and place of examination.
The medical referee shall, on receipt of a reference duly signed and sealed, fix a time and place for the examination of the seaman, and shall send notice accordingly to both the parties signing the application on which the reference is made.
Referee before certifying to personally examine seaman.
Before giving the certificate required by the reference, the medical referee shall personally examine the seaman and shall consider any statements that may be made or submitted by either party.
Form of certificate.
The certificate given by the medical referee shall be in accordance with Form 58 in the Schedule.
Certificate to be sent to registrar.
The medical referee shall forward his certificate to the prescribed authority from whom he received the reference.
Scale of referee fees.
The following shall be the scale of fees to be paid to medical referees in respect of references under this Division of these Regulations—
(a) for a first reference (to include all the duties performed in connexion therewith)....£2
(b) for a second or subsequent reference to the same medical referee in the same case..£1
(c) where, in order to examine the injured seaman, the medical referee is compelled to travel to a place distant more than 2 miles from his residence or such other centre as may be prescribed by the Minister, in addition to the above fees—5s. for each mile beyond 2 and up to 10 miles distant from such residence or centre, and thereafter 1s. 6d. for each mile distant therefrom.
Division 3.—References under Schedule I., Paragraph (19).
Referee to notify parties of time and place of examination.
The medical referee shall, on receipt of a reference duly signed and sealed, fix a time and place for the examination of the seaman, and shall send notice accordingly to the seaman.
Referee before certifying to personally examine seaman.
Before giving the certificate required by the reference the medical referee shall make a personal examination of the seaman.
Form of certificate.
The certificate given by the medical referee shall be in accordance with Form 60 in the Schedule.
Certificate to be sent to registrar.
The medical referee shall forward his certificate to the prescribed author by from whom he received the reference.
Fee of medical referee.
The fee to be paid to a medical referee in respect of a reference (to include all the duties performed in connexion therewith) tinder this Division of those Regulations shall be One pound.
Appointment of medical referees to report under paragraph (12) of Second Schedule of Act. Eng. r. 53.
101. (1) A committee, arbitrator, judge, or County Court may submit to a medical referee for report any matter which seems material to any question arising in an arbitration.
(2) When any matter is submitted, the committee, arbitrator, judge, or County Court may, subject to and in accordance with these Regulations, order the injured seaman to submit himself for examination by the medical referee; and it shall be the duty of the seaman on being served with the order to submit himself for examination accordingly.
Division 4.—References under Schedule II., Paragraph (12).
Conditions of reference.
Before making any reference the committee, arbitrator, or judge shall be satisfied, after hearing all medical evidence tendered by either side, that such evidence is either conflicting or insufficient on some matter which seems material to a question arising in the arbitration, and that it is desirable to obtain a report from a medical referee on the matter.
Form and mode of reference.
(1) Every reference shall be made in writing, and shall state the matter on which the report of the medical referee is required, and the question arising in the arbitration to which the matter seems to be material.
(2) The reference may be in accordance with Form 61 in the Schedule.
(3) The reference shall be accompanied by a general statement of the medical evidence given on behalf of the parties.
(4) If the evidence has been given before a committee or agreed arbitrator, each medical witness shall sign the statement of his evidence, and may add any necessary explanation or correction.
Order for examination of seaman.
(1) On making the reference to the medical referee, the committee, arbitrator, or judge shall make an order in accordance with Form 62 in the Schedule, directing the injured seaman to submit himself for examination by the medical referee.
(2) Before making the order the committee, arbitrator, or judge shall inquire whether the seaman is in a fit condition to travel for the purpose of examination, and if satisfied that he is in a fit condition, they shall, by the same order, direct him to attend at such time and place as the referee determines.
(3) If the committee, arbitrator, or judge is satisfied that the seaman is not in a fit condition to travel, they shall so state in the reference.
(4) It shall be the duty of the injured seaman to obey the order.
Reference to be signed.
The reference shall be signed, if made by a committee, by the chairman and secretary of the committee; if made by an agreed arbitrator, by the arbitrator; if made by a judge or an appointed arbitrator, by the judge or arbitrator, or by the Registrar of the court in which the arbitration is pending.
Committee or agreed arbitrator need not name referee.
A committee or an agreed arbitrator making a reference shall, without naming a medical reference, address the reference in general terms to “one of the medical referees appointed by the Minister for the purposes of the Seaman's Compensation Act 1911,” and shall forward it to the Registrar of the County Court of the place in which the case arises.
Duties of Registrar.
(1) In the ease of a reference by a committee or agreed arbitrator, the Registrar on receiving the reference shall—
(a) see that the reference is in accordance with these Regulations, and if it is not, return it for amendment;
(b) insert the name of the referee proper to be appointed;
(c) when the reference is in accordance with these Regulations, countersign and seal it, and forward it forthwith to the medical referee.
(2) In the case of a reference by a judge or appointed arbitrator, the Registrar of the court in which the arbitration in pending shall sign (or countersign) and seal it, and forward it forthwith to the medical referee.
Registrar to file report of medical referee.
(1) The Registrar, on receiving the report from a medical referee under regulation 110, shall forthwith file a copy in the court and transmit the report to the committee, arbitrator, or judge by whom the reference was made.
(2) If the committee, arbitrator, or judge directs that the parties be at liberty to inspect the report, the Registrar shall, on receiving notice of the direction, permit the inspection to be made during office hours, and shall on the application and at the cost of any party furnish him with a copy of the report or allow him to take a copy thereof.
Medical referee, to appoint time and place for examination.
The medical referee shall, on receipt of a reference duly signed and sealed, appoint a time and place for the examination of the seaman, and shall send him notice accordingly.
Report of medical referee.
The medical referee shall give his report in writing, and shall forward it to the Registrar from whom he received the reference.
Further statement from referee.
The committee, arbitrator, or judge may, by request signed and forwarded in the same manner as the reference, remit the report to the medical referee for a further statement on any matter not covered by the original reference.
Fees.
The following shall be the scale of fees to be paid to the medical referees in respect of references under this Division of the Regulations:—
(i) For a first reference, to include examination of the injured seaman and written report. £2
(ii) For a further statement under regulation 111 on any matter not covered by the original reference £1
(iii) For a second or subsequent reference to the same referee on a further arbitration on the same case, to include examination, if necessary, and written report £1
(iv) Where in order to examine the injured seaman the medical referee is compelled to travel to a place distant more than two miles from his residence or such a centre as may be fixed by the Minister, in addition to the above fees: Five shillings for each mile beyond two and up to ten miles distant from the residence or centre, and thereafter One shilling for each mile distant therefrom.
Part V.—Miscellaneous.
Amendment of Second Schedule to Act.
The Second Schedule to the Act is amended—
(a) by inserting at the end of paragraph (2) thereof the words “or by arbitration before a judge of a Council Court;
(b) by inserting in paragraph (6) thereof, after the word “committee” (wherever it occurs), the words “a judge”; and
(c) by inserting in paragraph (12) thereof, after the word “arbitrator,” the word “judge”.
Review of weekly payment.
Any weekly payment may be reviewed at the request of an employer or seaman by arbitration in manner provided by these Regulations for the settlement of any matter by arbitration.
Returns of accidents and compensation.
(1) The owner or master of every vessel (except a vessel included in sub-regulation (3) of this regulation), in which seamen to whom the Act applies are employed, shall furnish to the Comptroller-General of Customs, not later than the 31st day of July and the 31st day of January in each year, a return setting forth the particulars required by paragraphs (a) and (b) of section 16 of the Act, for the six months ending on the 30th day of June and the 31st day of December respectively in each year.
(2) In addition to the returns required by sub-regulation (1) of this regulation, the owner or master of every vessel (except a vessel included in sub-regulation (3) of this regulation), at which seamen to whom the Act applies are employed, shall furnish to the Comptroller-General of Customs, not later than the 31st day of July and the 31st day of January in each year, a return in respect of each seaman to whom the Act applies, injured during the six months ending on the 30th day of June and the 31st day of December respectively in each year, setting forth the following particulars:—
Name of vessel.
Nationality.
Place of registry.
Date and place of accident.
Name of person injured.
Nature of employment.
Nature of injury.
Whether injury resulted in death.
Where injury does not result in death, period of incapacitation.
Amount of compensation paid.
Name and address of person to whom compensation paid, or where injury has resulted in death and no compensation has been paid, the home address of the seaman, as recorded in the ship’s articles.
Where injury results in death, relationship of person to whom compensation paid to person injured.
(3) In the case of a vessel not having an owner in Australia on which any seaman to whom this Act applies is employed, the master shall furnish to the Comptroller-General of Customs, within one week of the date of the accident or before clearance is granted, a return setting forth the particulars specified in sub-regulation (2) of this regulation in respect of each seaman, to whom the Act applies, injured while the vessel is in the territorial waters of the Commonwealth.
Matters how distinguished. Eng. r, 83.
Every matter brought under the Act shall be intituled in the matter of the Act and shall have a reference to the district or place in which it was instituted and be distinguished by a separate number; and all documents filed and subsequent proceedings taken in the court with reference to the 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 matter shall be entered together and shall be kept separate from the entries with respect to any other matter.
Forms in appendix or like forms may be used. Eng. r. 84.
The forms in the Schedule where applicable, and where they are not applicable, forms of like character, with such variations as the circumstances may require, may be used in proceedings under the Act.
Repeal.
The Seaman's Compensation Regulations 1912 (Statutory Rules 1913, No. 279) are hereby repealed.
______________________
THE SCHEDULE.
Form 1.
Application for Arbitration by Seaman with respect to the Compensation payable to him.
(a)
A.B.
and
1. On the day of personal injury by accident arising out of and in the course of his employment was caused to A.B.
employed in the capacity of on board the
ship
2. A question has [or questions have] arisen.
(a) as to whether the said A.B. is a seaman within the meaning of the above-mentioned Act; or
(b) as to the liability of the owners [or charterers] of the said ship 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 owners [or charterers] of the said ship to the said A.B. under the above-mentioned Act in respect of the said injury.
3. An arbitration under the above-mentioned Act is hereby requested between the said A.B. and the owners [or charterers] of the said ship “ ” for the settlement of the said question [or questions].
4. Particulars are hereto appended [or annexed]
____
Form 1—continued.
Of the applicant,
Of his solicitor,
The name and address of the person to be served, with this application as representing the owners or charterers of the ship are:—
[State name and address of managing owner or manager, or of master of ship. See Regulation 17.]
(Signed) Applicant.
Form 2.
Application for Arbitration by or on behalf of Dependants of Deceased Seaman.
(a)
In the matter of the Seamen's Compensation Act 1911.
E.F.
and
and
G.B.
[description] Respondent.
[or as the case may be; see Regulation 6.]
1. On the day of personal injury by accident arising out of and in the course of his employment was caused to A.B. , late of , deceased employed in the capacity of on board the ship , and on the day of the death of the said A.B. resulted from the injury [or, the ship which left the port of on or about the day of was lost with all hands on or about the day of ]
[or was last heard of on or about the day of and is believed to have been lost with all hands].
When the said ship left the said port A.B. , late of , was employed in the capacity of
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. was a seaman within the meaning of the above-mentioned Act; or
(b) as to the liability of the owners [or charterers] of the said ship to pay compensation under the above-mentioned Act to the dependants of the said A.B. in respect of the injury caused to them by the death of the said A.B. or
Form 2—continued.
(c) as to the amount of compensation payable by the owners [or charterers] of the said ship to the dependants of the said A.B. under the above-mentioned Act in respect of the injury caused to them by the death of the said A.B. ; or
(d) as to who are dependants of the said A.B.
(e) as to the apportionment and application of the compensation payable by the owners [or charterers] of the said ship to the dependants of the said A.B. in respect of the injury caused to them by the death of the said A.B.
[or as the case may be]
3. An arbitration under the above-mentioned Act is hereby requested between E.F. , the legal personal representative of the said A.B. [or between E.F. , a dependant of the said A.B.]
and the owners of the said ship and G.B. who claims or may be entitled to claim to be a dependant of the said A.B.
[or as the case may be; see Regulation 6].
for the settlement of the said question [or questions].
4. Particulars are hereto appended [or annexed].
Form 2—continued.
11. Particulars as to any persons claiming or who may be entitled to claim to be dependants, but as to whose claim a question arises, and who are therefore made respondents, with their names, addresses, and descriptions and occupations [if any]
12. Particulars of amount claimed as compensation, and of the manner in which the applicant claims to have such amount apportioned and applied
13. Date of service of statutory notice of accident and whether given before deceased voluntarily left the employment in which he was injured. [A copy of the notice to be annexed].
14. If notice not served, reason for omission to serve same ..
The name and address of the respondents to be served with this application are—
As representing the owners [or charterers] of the ship “ ”
[State name and address of managing owner or manager, or of master of ship. See Regulation 17].
and G.B.,
Form 3.
Application for Arbitration where Security has been given on behalf of the Owners of a Ship under Section 13.
[Heading of Court in which proceedings instituted.]
A.B.
and
[names and addresses of persons giving security]
1. On the day of personal injury by accident arising out of and in the course of his employment was caused to A.B. of and the said A.B. claims that the owners of the ship “ ” are liable under the Seamen’s Compensation Act 1911 to pay compensation in respect of the said injury.
2. The respondents have given security to abide the event of any proceedings that may be instituted in respect of the said injury, and to pay such compensation and costs as may be awarded thereon.
Form 3—continued.
3. A question has [or questions have] arisen [here state the questions, specifying only those which have arisen, e.g.]:—
(a) as to whether A.B. is a workman to whom the above-mentioned Act applies; or
(b) as to the liability of the owners of the said ship 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 to the said A.B. under the above-mentioned Act in respect of the said injury.
[or as the case may be.]
4. An arbitration under the above-mentioned Act is hereby requested between the said A.B. and the respondents for the settlement of the said question [or questions].
5. Particulars are hereto appended [or annexed].
[Here insert particulars of circumstances under which the application is made, and of the relief or order which the applicant claims, adapting the particulars in the preceding forms to the circumstances of the case.]
The names and addresses, &c. [as in Form 1.]
Note.—This form to be adapted as required to an application for arbitration as between the dependants of a deceased seaman and the persons giving security.
Form 4.
Application for Arbitration as to who are Dependants, or as to the Amount payable to each Dependant, where the total amount payable as Compensation to the Dependants of a Deceased Seaman has been agreed upon or ascertained.
(a)
E.F.
and
The owners [or charterers] of the ship “ ” and
G.H.
[description] Respondents.
[or as the case may be; see Regulation 7.]
1. On the day of personal injury by accident arising out of and in the course of his employment was caused to A.B. late of , deceased, employed in the capacity of on board the ship “ ” and on the day of the death of the said A.B. resulted from the injury [or, the ship “ ” which left the port of on or about the day of , was lost with all hands on or about the day of [or was last heard of on or about the day of , and is believed to have been lost with all hands.]
When the said ship left the said port, A.B. late of was employed in the capacity of
Form 4—continued.
2. The amount of compensation payable by the owners [or charterers] of the and ship to the dependants of the said A.B. under the above-mentioned Act in respect of the injury caused to them by the death of the said A.B. has been agreed upon [or ascertained], but a question has [or questions have] arisen
(a) as to who are dependants of the said A.B. within the meaning of the above-mentioned Act; or
(b) as to the apportionment and application of the compensation payable to the dependants of the said A.B.
3. An arbitration under the above-mentioned Act is hereby requested between E.F. , the legal personal representative of the said A.B. , acting on behalf of N.O. , P.R. , &c., dependants of the said A.B. [or between E.F. , N.O. , P.R. , &c., dependants of the said A.B. and the owners [or charterers] of the said ship and G.H. , who claims or may be entitled to claim to be a dependant of the said A.B.
[or as the case may be; see Regulation 7.]
for the settlement of the said question [or questions].
4. Particulars are hereto appended [or annexed].
Form 4—continued.
As representing the owners [or charterers] of the ship “ .”
[State name and address of managing owner or manager, or of master of ship See Regulation 17.]
and G.H.,
[or as the case may be.]
[or, Applicant's Solicitor.]
Form 5.
Application for Arbitration with respect to the Compensation payable in respect of Expenses of Medical Attendance and Burial, where Deceased Seaman leaves no Dependants.
(a)
E.F.,
[description] Applicant.
and
G.H.,
1. On the day of personal injury by accident arising out of and in the course of his employment was caused to A.B. late of , deceased, employed in the capacity of on board the ship “ ” and on the day of the death of the said A.B. resulted from the injury [or, the ship “ ” which left the port of on or about the day of was lost with all hands on or about the day of [or was last heard of on or about the day of and is believed to have been lost with all hands.]
When the said ship left the said port, A.B. late of was employed in the capacity of
2. The said A.B. left no dependants within the meaning of the above-mentioned Act.
3. A question has [or questions have] arisen.
(a) as to whether the said A.B. was a seaman to whom the above-mentioned Act applied; or
Form 5—continued.
(b) as to the liability of the said owners [or charterers] to pay compensation under the above-mentioned Act in respect of the reasonable expenses of the medical attendance on and the burial of the said A.B. ; or
(c) as to the amount of compensation payable by the said owners [or charterers] under the above-mentioned Act in respect of the reasonable expenses of the medical attendance on and the burial of the said A.B. ; or
(d) as to the apportionment and application of the compensation payable by the said owners [or charterers] under the above-mentioned Act in respect of the reasonable expenses of the medical attendance on and the burial of the said A.B.
4. An arbitration under the above-mentioned Act is hereby requested between E.F. and the owners [or charterers] of the said ship and G.H. for the settlement of the said question [or questions].
5. Particulars are hereto appended [or annexed].
————
1. Name and late address of deceased seaman ..........
2.Name of ship on which deceased was employed at the time of accident or loss of ship, and port of registry
3. Nature of employment of deceased at time of accident or loss of ship
4. Date and place of accident, nature of work on which deceased was then engaged and nature of accident and cause of injury [or date and place when and where ship lost or deemed to have been lost]
5. Nature of injury to deceased, and date of death [or date when ship was lost or is deemed to have been lost]
6. Name and address of applicant for arbitration.........
7. Character in which applicant applies for arbitration i.e., whether as legal personal representative of deceased or as a person to whom expenses in respect of which compensation is payable are due; and if the latter, particulars must be given of the circumstances under which the expenses are claimed to be due to the applicant
8. Particulars as to any other persons who claim that expenses in respect of which compensation is payable are due to them and who are therefore made respondents, with their names and addresses
9. Particulars of amount claimed as compensation, and of the manner in which the applicant desires such amount to be apportioned and applied
10. Particulars and items making up medical and funeral expenses
11. Date of service of statutory notice of accident on respondent from whom compensation is claimed and whether given before deceased 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..
Form 5—continued.
As representing the owners [or charterers] of the ship “ ”
[State name and address of managing owner or manager, or of master of ship. See Regulation 17.]
and
G.H.
Form 6.
Application for Arbitration with respect to the Review, Termination, Diminution Increase, or Redemption, of a Weekly Payment.
(a)
Applicants,
and
A.B.
Respondent.
[or as the case may be; see Act, Sched. 1 pars. 17 and 18.]
An arbitration under the Seamen’s Compensation Act 1911 is hereby requested between the owners [or charterers] of the ship “ ” and A.B.
[or as the case may be; see Act, Sched. 1, pars. 17 and 18.]
with respect to the review and termination [or diminution, increase, or redemption [as the case may be] of the weekly payment payable to the said A.B.] under the said Act in respect of personal injury caused to him by accident arising out of and in the course of his employment.
Particulars are hereto appended [or annexed].
1. Name and address of injured seaman............
2. Name of ship on which applicant was employed at the time of the accident and port of registry
3. Date and nature of accident...................
4. Date of agreement, decision, or award, fixing weekly payment, and date from which it commenced.
5. Relief sought by applicant, whether termination, diminution, increase or redemption
6. Grounds on which termination, diminution, or increase is claimed
Form 6—continued.
The names and addresses of the applicants and their solicitors are—
Of the Applicants, as representing the owners [or charterers] of the ship “ ”
[State name and address of managing owner or manager, or of master of ship. See Regulation 17].
Of their Solicitor,
Applicants.
Form 7.
Application for Arbitration where Rights of Employer against Insurers are Transferred to Seaman under Section 8.
(a)
A.B.
and
[Name and address of insurers] Respondents.
1. On the day of personal injury by accident arising out of and in the course of his employment was caused to A.B. employed in the capacity of on board the ship “ ” and the said A.B. claims that the owners [or charterers] thereupon became liable to pay compensation under the Seamen’s Compensation Act 1911 to the said A.B. in respect of the injury.
[Or, where weekly payment has been settled.]
1. Under an agreement [or a decision, or an award] recorded at on the day of a weekly payment of is payable by the owners [or charterers] of the ship “ ” as compensation for personal injury caused to the said A.B. by accident arising out of and in the course of his employment in the capacity of employed on the said ship.
2. The respondents are insurers of the owners [or charterers] of the said ship “ ” in respect of his [or their] liability to pay such compensation.
3. The owners [or charterers] of the said ship “ ” have become insolvent [or made a composition or arrangement with their creditors [or if the employer is a company, the said has commenced to be wound up], and the rights of the owners [or charterers] of the said ship “ ” against the respondents as such insurers in respect of their liability to the said A.B. have, by virtue of section 8 of the said Act, been transferred to and vested in the said A.B.
Form 7—continued.
4. 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. is a seaman to whom the above-mentioned Act applies; or
(b) as to the liability of the owner [or charterer] of the said ship “ ” to pay compensation under the above-mentioned Act in respect of the said injury; or
(c) as to the liability of the respondents as such insurers as aforesaid in the said A.B. ; or
(d) as to the amount [or duration] of the liability of the respondents as such insurers as aforesaid to the said A.B.
5. An arbitration under the above-mentioned Act is hereby requested between the said A.B. and the respondents for the settlement of the said question [or questions].
6. Particulars are hereto appended [or annexed].
[Here insert particulars containing a concise statement of the circumstances under which the application is made, and of all matters necessary to be stated in order to bring the questions to be settled properly at the arbitration, and of the relief or order which the applicant claims, adapting the particulars given in the preceding Forms to the circumstances of the case.]
Of his Solicitor,
(Signed) Applicant
Note.—This Form to be adapted as required to an application for arbitration as between the dependants of a deceased seaman and insurers.
Form 8.
Notice to Applicant of Day upon which Arbitration will be proceeded with.
Take Notice that His Honour a judge of this court [or Mr. the arbitrator appointed by the court], will proceed with the Arbitration in this matter at on the day of at the hour of o’clock in the noon or so soon thereafter as the parties can be heard.
To
Of
Form 9.
Notice to Respondent of Day upon which Arbitration will be proceeded with.
Take Notice that His Honour a judge of this Court [or Mr. the arbitrator appointed by the Court], will proceed with the Arbitration applied for in the request and particulars, a scaled copy of which is served herewith at on the day of at the hour of o’clock in the noon or so soon thereafter as the parties can be heard, and that if you do not attend either in person or by your solicitor at the time and place above-mentioned such order will be made and proceedings taken as the judge [or arbitrator] thinks just and expedient.
And further take notice, that if you wish to disclaim any interest in the subject-matter of the Arbitration, or consider that the Applicant's particulars are in any respect inaccurate or incomplete, or desire to bring any fact or document to the notice of the judge [or arbitrator], or intend to rely on any fact, or to deny (wholly or partially) your liability to pay compensation under the Act, you must file with me an answer, stating your name and address and the name and address of your solicitor (if any), and stating that you disclaim any interest in the subject-matter of the Arbitration, or stating in what respect the Applicant's particulars are inaccurate or incomplete, or stating concisely any fact or document which you desire to bring to the notice of the judge [or arbitrator] or on which you intend to rely, or the grounds on and extent to which you deny liability to pay compensation.
Such answer, together with a copy thereof for the judge [or arbitrator] and a copy for the Applicant and for each of the Respondents, must be filed with me ten clear days at least before the day of
If no answer is filed, and subject to such answer, if any, the Applicant's particulars and your liability to pay compensation will be taken to be admitted.
To
Of
Form 10.
Affidavit of Service of copy of request for Arbitration and Particulars Notices.
(a)
E.F.,
[description] Applicant.
and
and
G.H.,
[description] Respondents.
I, A.B., of
or G.H., a clerk [or servant] in the permanent and exclusive employ of ;
[or L.M. , of , the solicitor for ], [or R.S. , of solicitor, agent for L.M. , of solicitor for ]; [or X.Y., a clerk in the employ of [R.S., of solicitor, agent for] L.M. , of solicitor for ], the above-mentioned plaintiff, make oath and say:—
1.That I, [ , am a clerk [or servant] in the permanent and exclusive employ of ,] [or am a clerk in the employ of [R.S. of , solicitor, agent for] L.M., of , solicitor for] the above-named plaintiff, and that I am over sixteen years of age.
Form 10—continued.
2. That I did on the day of 19 , duly serve the owners [or charterers] of the ship “ ,” the above-named respondent [or one of the above-named respondents] with the copy of request for Arbitration herein and particulars thereof [or as the case may be], a true copy of which is hereunto annexed, marked “A,” by leaving the same at the office of the managing owners or manager of the said ship “ ” [or by delivering the same personally to the manager or to the master of the said ship “ ” [insert time, place, and mode of service] or as the case may be].
Sworn at , in the State of on the
day of 19 , before me,
A Commissioner for taking declarations [or affidavits],
[Indorse the copy request or other matter:—This paper marked “A” is the paper referred to in the annexed affidavit.]
Form 11.
answer by respondents.
[Not to be Printed, but to be used, as a Precedent.]
That the respondent G.H. disclaims any interest in the subject-matter of the above arbitration.
Or
That the respondents the owners [or charterers] of the ship “ ” state that the applicant's particulars filed in this matter are inaccurate or incomplete in the particulars hereto annexed.
Or
That the respondents, the owners [or charterers] of the ship “ ” desire to bring to the notice of the judge [or arbitrator] the facts stated in the particulars hereto annexed.
Or
That the respondents, the owners [or charterers] of the ship “ ”, intend at the hearing of the arbitration to give evidence and rely on the facts stated in the particulars hereto annexed.
Or
That the respondents, the owners [or charterers] of the ship “ ” deny their liability to pay compensation under the Act in respect of the injury to A.B., , mentioned in the applicant's particulars, on the grounds stated in the particulars hereto annexed.
Form 11—continued.
1. Particulars in which the particulars filed by the Applicant are inaccurate or incomplete.
2. Facts which the respondents desire to bring to the notice of the Arbitrator—
That the applicant A.B. refuses to submit himself to medical examination as required by [or obstructs the medical examination required by] the respondents, the owners [or charterers] of the ship “ ” in accordance with paragraph 5 of the First Schedule to the Act [or refuses to submit himself for examination by a medical referee as ordered] [or obstructs the examination by a medical referee ordered in accordance with paragraph 13 of the First Schedule of the Act]
3. Facts which the respondent, the owners [or charterers] of the ship “ ” intend to give in evidence and rely on at the hearing of the Arbitration:—
That notice of the alleged accident [or of death or disablement] was not given to the respondents as required by the Act; or
That the claim for compensation was not made on the respondents within the time limited by the Act; or
[or as the case may be],
4. Grounds on which the Respondents deny their Liability to pay Compensation—
(i) That the applicant A.B. is [or the deceased seaman was] not a seaman to whom the Act applies; or
(ii) That the injury to the applicant [or to the deceased seaman] was not caused by accident arising out of and in the course of his employment; or
(iii) That the injury to the applicant [or to the deceased seaman] was attributable to the serious and wilful misconduct of the applicant [or of the deceased seaman] and did not result in death or serious and permanent disablement; or
(iv) That at the time of the alleged accident the applicant [or the deceased seaman] was not immediately employed by the respondents, but was employed by of , a contractor with the respondents for the execution by or under such contractor of work undertaken by the respondents, and the accident occurred elsewhere than on or about premises on which the respondents had undertaken to execute the work or which were otherwise under the control or management of the respondents; or
(v) That the injury to the applicant [or to the deceased seaman] was caused under circumstances creating a legal liability in a person other than the respondents, to wit [name and address of such person] to pay damages in respect thereof, and the applicant [or the deceased seaman] has taken proceedings against that person and has recovered damages from him;
And further take notice, that the names and addresses of the said respondents and their solicitors are—
Of the Respondents, as representing the owners [or charterers] of the ship “ ,”
[State name and address of managing owners or manager or of master of ship. See Regulation 17.]
Of their Solicitors,
Solicitors for the Respondent,
To the Registrar of the County Court at and
To the Applicant, A.B., and
if any [naming them].
form 12.
Notice by Respondent admitting Liability, and submitting to an Award for Payment of a Weekly Sum, or paying Money into Court.
That the respondents, the owners [or charterers] of the ship “ ” admit their liability to pay compensation in the above-mentioned matter.
And they hereby submit to an award for payment by them to the applicant A.B. of the weekly sum of such weekly payment to commence as from the day of and to continue during the total or partial incapacity of the said A.B. for work, or until the same shall be ended, diminished, increased, or redeemed in accordance with the provisions of the above-mentioned Act.
And for payment by them to the applicant forthwith after the award of the amount of such weekly payments calculated from the day of until the first Saturday [or other usual pay day] after the date of the award, and for the payment thereafter of the said sum of to the applicant, on Saturday [or other usual pay day] in every week.
[Or, And the owners [or charterers] of the said ship “ ” herewith pay in to the County Court at the sum of £ in satisfaction of such liability.]
Solicitors for the Respondents.
To the Registrar of the County Court at and
To the Applicant. A.B., and
if any [naming them].
Form 13.
Notice of Filing of Submission to an Award.
That the respondents, the owners [or charterers] of the ship “ ” have this day filed with me a notice (copy of which is sent herewith) that they admit their liability to pay compensation in the above-mentioned matter, and submit to an award for payment by them to you of the weekly sum of
If you elect to accept such weekly sum in satisfaction of your claim, you must send to the Registrar of this court and to the owners [or charterers] of the ship “ ” a written notice forthwith by post, or leave such notice at the office of the Registrar of such Court, and at the place of business of the owners [or charterers] of the said ship “ .”
If you send such notice, a judge of this court will, on application made to him, make an award directing payment of such weekly sum to you and you will be liable to no further costs.
In default of such notice, the Arbitration will be proceeded with; and if no greater weekly payment is awarded to you will be liable to be ordered to pay the costs incurred by the respondents subsequent to the receipt by you of this notice.
To the Applicant, A.B.
Form 14.
Notice of Payment into Court.
[Heading as in Request for Arbitration].
That the respondents, the owners [or charterers] of the ship “ ” have this day filed with me a notice that they admit their liability to pay compensation in the above-mentioned matter, and they have paid into the County Court at sum of £ in satisfaction of such liability.
If you are willing to accept the sum so paid into court in satisfaction of the compensation payable in the above-mentioned matter, you must send to the Registrar of the said court, and to the owners [or charterers] of the said ship, and to the other respondents [or where this notice is sent to a respondent, to the applicant and the other respondents] a written notice forthwith by post, or leave such notice at the office of the said Registrar, and at the residence or place of business of the owners [or charterers] of the said ship and at the place of business of each of the other respondents [or of the applicant and each of the other respondents].
If you and all the other respondents [or If you and the applicant and all the other respondents] send such notice, and agree as to the apportionment and application of the said sum of £ a judge of this court will on application made to him, make an award for such apportionment and application, and you will be liable to no further costs.
If you and all the other respondents [or If you and the applicant and all the other respondents] send such notice, but do not agree as to the apportionment and application of the said sum of £ , the arbitration will be proceeded with between you and such other respondents or as between the applicant and yourself and such other respondents].
In default of such notice being sent by you and all the other respondents [or by the applicant and yourself and all the other respondents] the arbitration will be proceeded with; and if no greater amount than the said sum of £ is awarded as compensation, the parties who do not send such notice will be liable to be ordered to pay the costs incurred by the respondents, the owners [or charterers] of the said ship, subsequent to the receipt by such parties of this notice and also any costs incurred subsequent to the receipt of this notice by any parties who send notice of their willingness to accept the said sum of £ in satisfaction of the said compensation payable in the above-mentioned matter.
To the Applicant A.B.
[or To the Respondent G.H.]
Form 15.
Notice of Acceptance of Weekly Sum offered, or of Willingness to accept Sum paid into Court.
That the applicant, A.B., accepts the weekly sum offered by the respondents, the owners [or charterers] of the ship “ ” in satisfaction of his claim in the above-mentioned matter [or that the applicant, E.F. [or the respondent, G.H.], is willing to accept the sum of £ paid into court by the respondents, the owners [or charterers of the ship “ ” in satisfaction of the compensation payable] in the above-mentioned matter].
Form 15—continued.
But the applicant [or the said respondent, G.H., ] will apply to the judge to include in his award an order directing the said respondents, the owners [or charterers] of the said ship, to pay the costs properly incurred by the applicant [or the said respondent, G.H. ] before the receipt of notice of the offer of the said weekly sum [or of notice of payment of the said sum of £ into court], and his costs properly incurred in relation to the notice of the offer of the said weekly sum [or the notice of payment of the said sum of £ into court] and to this notice and in attending the arbitrator to obtain an award.
[Or
Respondent.]
To the Registrar of the County Court at and,
To the Respondents, the owners [or charterers] of the ship “ ,” and
To the Applicant, A.B., and
[naming them].
Form 16.
Notice by Respondent to Third Parties.
[Not to be Printed, but to be used as a Precedent.]
To Mr. , of [Address and description.]
That A.B. , of, &c., , has filed a request for arbitration (a copy whereof is hereto annexed) as to the amount of compensation payable by the respondents, the owners [or charterers] of the ship “ ”, to the said A.B. in respect of personal injury caused to the said A.B. by accident arising out of and in the course of his employment.
[Or that E.F., , of , has filed a request for arbitration (a copy whereof is hereto annexed) with respect to the compensation payable to the dependants of A. B. , deceased, in respect of the injury caused to the said dependants by the said A.B. , which resulted from injury caused to the said A.B. by accident arising out of and in the course of his employment.]
[Or, as the case may be. See Forms of Request for Arbitration.]
The respondents, the owners [or charterers] of the said ship, claim to be indemnified by you against their liability to pay such compensation, on the ground that at the time of the injury in respect of which compensation is claimed by the said A.B. was not immediately employed by the owners [or charterers] of the said ship, but was employed by you in the execution of work undertaken by the owners [or charterers] of the said ship, in respect of which the owners [or charterers] of the said ship had contracted with you for the execution thereof by or under you.
[Or on the ground that the injury for which compensation is claimed was caused under circumstances creating a legal liability on your part to pay damages in respect thereof.]
[Or as the case may be.]
And take notice, that if you wish to dispute the applicant's claim as against the respondents, the owners [or charterers] of the said ship, or your liability to the said respondents, you must appear before the judge [or arbitrator] at the time and place mentioned in the notice, a copy of which is hereunto annexed.
Form 16—continued.
In default of your so appearing you will be deemed to admit the validity of any award made in the said arbitration as to any matter which the judge [or arbitrator] has jurisdiction to decide in such arbitration as between the applicant and the respondents, the owners [or charterers] of the said ship, whether such award is made by consent or otherwise, and your own liability to indemnify the owners [or charterers] of the said ship [or to contribute as above-mentioned].
Managing Owners or Manager,
(as representing the owners [or
charterers] of the said ship),
[Or
Solicitors for the Respondents,
(the owners [or charterers]
of the said ship).
To
Of
Form 17.
Award.
Note.—These forms are intended for use in ordinary cases only. The award in any special case must be settled under Regulation 30 in accordance with the directions given by the judge or arbitrator.
(i) In case of Application by Seaman.
Having duly considered the matters submitted to me, I do hereby make my award as follows:—
[Here insert any introductory recitals of findings on which the award is made which the judge or magistrate may direct.]
1. I order that the respondents, the owners [or charterers] of the ship “ ” do pay to the applicant A.B. the weekly sum of as compensation for personal injury caused to the said A.B. on the day of , by accident arising out of and in the course of his employment as a seaman employed by the said respondents, such weekly payment to commence as from the day of and to continue during the total or partial incapacity of the said A.B. for work, or until the same shall be ended, diminished, increased, or redeemed in accordance with the provision of the above-mentioned Act.
(1) First Saturday or other usual pay day after date of award.
(2) Or other usual pay day.
2. And I order that the owners [or charterers] of the said ship do forthwith pay to the said A.B. the sum of £ being the amount of such weekly payments calculated from the day of until the day of (1) and do thereafter pay the said sum of to the said A.B. on Saturday (2) in every week.
3. And I order that the owners [or charterers] of the said ship do pay to the Registrar of the County Court at for the use of the applicant, his costs of and incident to this arbitration, such costs, in default of agreement between the parties as to the amount thereof, to be taxed by the said Registrar under scale of costs and to be paid by the said owners [or charterers] to the said Registrar within fourteen days from the date of the certificate of the result of such taxation.
Judge [or Arbitrator.]
Form 17—continued.
(ii) In case of Application by Dependants.
Having duly considered the matter submitted to me, I do hereby make award as follows:—
[Here insert any introductory recitals of findings on which the award is notice which the judge or magistrate may direct.]
1. I, order that the respondents, the owners [or charterers of the ship “ ” do pay the sum of £ to the dependants of A.B. late of deceased, as compensation for the injury resulting to such dependants from the death of the said A.B. which took place on the day of from injury caused to the said A.B. on the day of by accident arising out of and in the course of his employment as a seaman employed by the said respondents.
2. And I declare that the persons hereinafter named are entitled to share in such compensation as dependants of the said A.B. that is to say J.B. , the widow of the said A.B. and (1)
(1) Name the other persons.
3. [Add, if so found.] And I declare that the respondent G.H. the of the said A.B. , is not entitled to share in such compensation as a dependant of the said A.B.
4. And I order that the said sum of £ be apportioned between the said J.B. and (1) in the proportions following, that is to say:—
I apportion the sum of £ to or for the benefit of the said J.B. and the sum of £ to or for the benefit of the said (2)
(2) Specify the persons entitled and the sums apportioned to them.
5. And I order that the owners [or charterers] of the said ship do pay the said sum of £ to the prescribed authority within 14 days from the date of this award.
6. And I order that the owners [or charterers] of the said ship do pay to the Registrar of this court at for the use of the applicants their costs of and incident to this arbitration, such costs, in default of agreements between the parties as to the amount thereof, to be taxed by the Registrar under scale of costs used in the County Courts and to be paid by the owners [or charterers] to the Registrar within 14 days from the date of the certificate of the result of such taxation.
[Add directions (if any given) as to costs occasioned by claim of person claiming as a dependant whose claim is disallowed.]
Dated this day
Judge [or Arbitrator],
(iii) In case of Application by Person to whom expenses of Medical Attendant or Burial are due.
Having duly considered the matters submitted to me, I do hereby make my award as follows:—
[Leave space for any introductory recitals of findings on which the award is made which the judge or magistrate may direct.]
1. I order that the respondents, the owners [or charterers] of the ship “ ” do pay the sum of £ for or towards the expenses of medical attendance on and the burial of A.B. late of deceased, who died on the day of from injury caused on the day of by accident arising out of and in the course of the employment of the said A.B. as a seaman employed by the owners [or charterers] of the said ship.
Form 17—continued.
2. And I declare that the persons hereinafter named are entitled to share in such compensation, that is to say:—
The applicant E.F. in respect of charges amount to £ due to [or payable by] him for medical attendance on the said A.B. and the respondent G.H. in respect of charges amount to £ due to him for the burial of the said A.B.
3. And I order that the respondents, the owners [or charterers] of the said ship do pay the said sum of £ to the Registrar of this court within 14 days from the date of this award, and that the said sum of £ be apportioned between and paid to the said E.F. and G.H. in proportion to the amounts due to them respectively as aforesaid.
4. And I order that the owners [or charterers] of the said ship do pay to the Registrar of this court for the use of the applicant E.F. and the respondent G.H. their respective costs of and incident to this arbitration, such costs, in default of agreement between the parties as to the amount thereof to be taxed by the Registrar under scale of costs in use in the County Courts and to be paid by the owners [or charterers] of the said ship to the Registrar within 14 days from the date of the certificate of the result of such taxations.
Judge [or Arbitrator].
[Note.—The above forms will serve as guides for framing awards in other cases of arbitration.]
Form 18.
Notice of Day upon which Special Case will be heard.
In the County Court of holden at
[Heading as in Special Case.]
Take Notice that the judge of this court will hear the special case stated in the above-named, at a court to be holden at on the day of at the hour of in the noon; and that if you do not attend in person or by your solicitor at the place and time above-mentioned, such order will be made and proceedings taken as the judge thinks just.
You may obtain a copy of the case upon application at my office and upon prepayment of the costs of such copy.
To [the applicant and respondents]
Form 19.
Application for Order for Detention of Ship.
[(a) Heading of the Court where proceedings commenced.]
The Seamen’s Compensation Act 1911, section 13.
Application is hereby made on behalf of of who alleges that the owners of the ship “ ” which has been found in the port [or river] of [or within the territorial waters of Australia] are liable as owners to pay compensation under the Seaman’s Compensation Act 1911, in respect of personal injury by accident arising out of and in the course of his employment caused to of on the day of , and who claims compensation in respect of the injury, and alleges that none of the owners of the said ship reside in Australia, for an order directed to an officer of the Department of Trade and Customs or other officer named by the judge, requiring him to detain the said ship until such time as the owners, agent, master, or consignee thereof, have paid the compensation, or have
Form 19—continued.
given security, to be approved by the judge, to abide the event of any proceedings that may be instituted to recover the compensation, and to pay such compensation and costs as may be awarded thereon, or until the said ship shall be otherwise released by due course of law.
The grounds on which this application is made are set forth in the affidavit of filed herewith [or will be given in evidence on the hearing of the application].
[Name and address of Applicant or Applicant’s Solicitor.]
Form 20.
Undertaking as to Damages.
[Heading of Court in which proceedings commenced.]
The Seamen’s Compensation Act 1911, section 13.
I, the undersigned, of hereby undertake to abide by an order which may hereafter be made as to damages, in case any person affected by the order to be made on my application for the detention of the ship “ ” shall sustain any damages by reason of such order which I ought to pay.
[Signature and address of applicant.]
[To be altered as required, if the undertaken is given by any person other than the applicant.]
Form 21.
Order for Detention of Ship.
Whereas it is alleged that the owners of the ship “ ” are liable as such owners to pay compensation in respect of personal injury by accident arising out of and in the course of his employment, caused to of :
And that the said ship has been found in the port [or river] of [or within the territorial waters of Australia]:
And whereas it has been shown to me, on the application of of who claims compensation in respect of the injury, that the owners of the said ship are probably liable as such to pay compensation, and that none of the owners reside in Australia:
And whereas the said has filed an undertaking to abide by an order which may hereafter be made as to damages, in case any person affected by this order shall sustain any damages by reason of this order which the said ought to pay:
Form 21—continued.
Now I do hereby issue this order directed to you, the Collector of Customs at [or other officer named by the judge] require you to detain the said ship until such time as the owners, agent, master, or consignee thereof have paid compensation in respect of the said injury, or have given security in the sum of £ ,to be approved by the judge, to abide the event of any proceedings that may be instituted to recover the compensation, and to pay such compensation and costs as may be awarded thereon, or until the said ship shall be otherwise released by due course of law.
Judge.
[or other officer named by the judge.]
Form 22.
Bond by Way of Security.
Whereas it is alleged that the owners of the ship “ ” are liable as such owners to pay compensation in respect of personal injury by accident arising out of and in the course of his employment, caused to of :
And whereas a judge of this court has issued an order directed to the Collector of Customs at [or other officer named by the judge] requiring him to detain the said ship until such time as the owners, agent, master, or consignee thereof have paid compensation in respect of the said injury, or have given security in the sum of £ to be approved by the judge, to abide the event of any
proceedings that may be instituted to recover the compensation, and to pay such compensation and costs as may be awarded thereon, or until the said ship shall be otherwise released by due course of law:
Now, therefore, we [state names, addresses, and descriptions of sureties] jointly and severally submit ourselves to the jurisdiction of this court, or of any other competent court in the Commonwealth in which any proceedings may be instituted in respect of the said injury, and consent that if the owners, agent, master, or consignee of the said ship shall not pay all such compensation, and costs as may be awarded thereon, execution may arise forthwith against us, our heirs, executors, and administrators, goods and chattels, for a sum not exceeding £
[Signature of Sureties.]
This bond was signed by the said and the sureties, the day of
Before me,
Form 23.
Order of Release.
You are hereby authorized and directed to release the ship “ ” now under detention by virtue of an order made on the day of upon the payment of all costs, charges, and expenses attending the custody thereof.
Judge.
[or other officer named in the order of detention].
Form 24.
Solicitors undertaking to give Security.
Whereas it is alleged that the owners of the ship “ ” are liable as such owners to pay compensation in respect of personal injury by accident arising out of and in the course of his employment caused to of :
Now, therefore, I, L.M. of solicitor for the owners [agent, master or consignee] of the said ship, hereby undertake within days from the date hereof to put in or give security in the sum of £ , to be approved by the judge, to abide the event of any proceedings that may be instituted to recover the compensation, and to pay such compensation and costs as may be awarded thereon.
(Signed) L.M.
Form 25.
Application for Appointment of New Arbitrator.
(Schedule II., Paragraph (7.))
In the matter of an arbitration between A.B.
and
Application is hereby made to the court on behalf of the above-named to appoint a new arbitrator in the above-mentioned matter in the place of Mr. the arbitrator appointed therein, by reason of the death [or refusal, [or inability] to act] of the said Mr.
And the applicant hereby requests that a time and place may be fixed for the hearing of the application.
Form 26.
Summons on Application for Appointment of new Arbitrator.
[Title as in Application.]
You are hereby summoned to attend before the judge in chambers at on the day of at the hour of in the noon, on the hearing of an application on the part of for the appointment by the judge of a new arbitrator in the above-mentioned matter in the place of Mr. the arbitrator appointed thereon, by reason of the death [or refusal [or inability] to act] of the said Mr.
And take notice that in default of your attendance at the time and place above-mentioned, the judge will, on proof of the service of this summons, proceed to hear and dispose of the said application.
To
and to his [or their] solicitor.
Form 27.
Form of Memorandum under Paragraph (8) of Schedule II.
(i) In case of Injury to Seaman by Accident.
To the Collector of Customs for the State of
In the matter of the Seamen’s Compensation Act 1911,
and
A.B.
and
[Or, where the matter has been decided by agreement without arbitration],
In the matter of an agreement between
A.B.
and
The owners [or charterers] of the ship “ .”
Be it remembered, that on the day of personal injury was caused to the above-named A.B. by accident arising out of and in the course of his employment:
And that on the day of the following agreement was come to by and between the said A.B. and the owners [or charterers] of the said ship, that is to say:
[or That on the day of the following decision was given by a committee representative of the owners [or charterers] of the said ship and their seamen, having power to settle matters under the above-mentioned Act in the case of the said owners [or charterers] and their seamen, that is to say:]
[or That on the day of the following award was made and given by me, the undersigned , being an arbitrator agreed on by the said A.B. and the owners [or charterers] of the said ship [or appointed by the County Court of ,] that is to say:]
[Here set out copy of agreement, decision, or award.]
[or where death resulted from the accident.]
Be it remembered, that on the day of personal injury was caused to E.F., late of deceased, a seaman employed on the ship “ ” by accident arising out of and in the course of his employment, and that on the day of the said E.F. died as a result of the injury:
[or That the ship “ ,” which left the port of on or about the day of was lost with all hands on or about the day of [or was last heard of on or about the day of , and is believed to have been lost with all hands, and that E.F., of ,was a seaman employed on the said ship]:
And that on the day of the following agreement was come to by and between A.B. and G.H. the dependants of the said E.F. within the meaning of the above-named Act, and the owners [or charterers] of the said ship, that is to say:
[or That on the day of the following decision was given by a committee representative of the owners [or charterers] of the said ship and their seamen, having power to settle matters under the above-mentioned Act in the case of the said owners [or charterers] and their seamen, that is to say:]
[or That on the day of the following award was made and given by me, the undersigned \ , being an arbitrator agreed on by A.B. and G.H. the dependants the said E.F. within the meaning of the above-mentioned Act, and the owners [or charterers] of the said ship [or appointed by the County Court of ,] that is to say:]
[Here set out copy of agreement, decision, or award.]
A copy of the report of Mr. , a medical referee appointed to report on the above-mentioned matter, is hereunto annexed.
Form 27—continued.
You are hereby requested to record this memorandum pursuant to paragraph 8 of the Second Schedule to the above-mentioned Act.
[To be signed—
In the case of an agreement, by the parties or some or one of them, or by their or his solicitor on their or his behalf:
In the case of a decision by a committee, by the chairman and secretary on behalf of the committee:
In the case of an award, by the arbitrator.]
Note.—This form to be adapted to the circumstances of the case and the matter decided.
Form 28.
Information to be supplied where a Memorandum of an Agreement as to the redemption of a weekly payment by a lump sum, or as to the amount of compensation payable to a person under any legal disability, or to dependants, is presented for registration. Schedule II. Paragraph (8).
A. In case of agreement with injured Seaman.
(a) A.B. named in the memorandum of agreement presented for registration in this matter was at the date of the accident years of age.
(b) He was employed as and his average weekly earnings computed in accordance with the above-mentioned Act were
(c) He was injured by and the nature of his injury was as follows:—
(d) He was totally incapacitated for work for a period of but recovered and was fit to resume his ordinary work on the day of 19 ;
[or He was and is at present totally incapacitated for work, but is expected to recover and to be fit to resume his ordinary work in about ];
[or He was totally incapacitated for work for a period of and is now partially incapacitated, but such partial incapacity is not likely to be permanent, and he is expected to recover and to be fit to resume his ordinary work in about ];
[or He was and is totally incapacitated for work and such incapacity is likely to be permanent];
[or He was totally incapacitated for work for a period of and is still partially incapacitated and such partial incapacity is likely to be permanent, but he is able to do light work, and it is estimated that he is able to earn an average weekly amount of in some suitable employment or business];
(e) The said received the following payments, allowances, or benefits from his employers previous to the date of the agreement, viz.:—
[Here state payments made, and where a weekly payment has been made, the amount of such payment, and the period for which it was paid.]
Dated this day of , 19 .
B. Where death resulted from injury.
(a) A.B. named in the memorandum of agreement presented for registration in this matter was at the date of the accident [or death] years of age.
(b) He was employed as and his earnings in the employment of during the three years next preceding the injury in the said memorandum mentioned [or his average weekly earnings during the period of his employment under ] were
Form 28—continued.
(c) He left the following dependants wholly dependent upon his earnings, and the following dependants partly dependent, viz.:—
Here state dependants, with their relationship to the deceased, and particulars showing how and to what extent they were dependent.]
[or He left no dependants wholly dependent upon his earnings, but left the following dependants partly dependent, viz.:—
Here state dependants, with their relationship to the deceased, and particulars showing how and to what extent they were dependent.]
(d) The said received the following payments, allowances, or benefits from his employers after the accident [or disablement], viz.:—
Dated this day of 19 .
Form 29.
Notice of Memorandum having been received.
Take Notice that a memorandum, copy of which is hereto annexed, has been sent to me for registration.
Such memorandum appears to affect you.
I have therefore to request you to inform me within 7 days from this date whether you admit the genuineness of the memorandum, or whether you dispute it, and if so, in what particulars, or object to its being recorded, and if so, on what grounds.
If you do not inform me in due course that you dispute the genuineness of the memorandum, or object to its being recorded, it may be recorded without further inquiry, and will be enforceable accordingly.
If you dispute its genuineness or object to its being recorded, it will not be recorded, except with your consent in writing, or by order of a judge of a County Court.
Collector of Customs for the
To
Form 30.
Notice disputing Memorandum or objecting to its being recorded.
Take Notice that the owners [or charterers] of the ship “ ” dispute genuineness of the memorandum sent to you for registration in the above mentioned matter in the following particulars:—
[Here state particulars.]
[Or,
Take Notice that the owners [or charterers] of the ship “ ” object to the memorandum sent to you for registration in the above-mentioned matter being recorded, on the following grounds:—
[Here state grounds. See particularly Schedule 2, para. (8), proviso (b)].
Dated this day of , .
As representing the owners [or charterers] of
the ship “ ”
(Signature of managing owners or manager or master of the ship.)
[Or,
Solicitors for the owners [or charterers] of
the ship “ ”.]
To
The Collector of Customs for the State of
Form 31.
Notice that Memorandum is Disputed, or of Objection to its being recorded.
Take Notice that the genuineness of the memorandum in the above-mentioned matter left [or sent to] me for registration is disputed by of a party affected by such memorandum, in the following particulars:
[here state particulars of dispute]
[or That of a party interested in the memorandum in the above-mentioned matter left with for sent to] me for registration objects to the same being recorded, on the following grounds:]
[here state grounds]
The memorandum will therefore not be recorded except with the consent in writing of the said , or by order of a judge of a County Court.
Collector of Customs for the State of
To
Form 32.
Notice of Application for Registration of Memorandum or for Rectification of Register.
(a)
Take Notice that I intend to apply to the judge of the County Court at o’clock on the day of , at the hour of in the noon [in case of notice by solicitor, on behalf of of ] for an order for the registration of the memorandum sent to the Collector of Customs for the State of in the above-mentioned matter [or for an order for the rectification of the memorandum recorded in the above-mentioned matter] by [state particulars of rectification applied for] and for consequential directions, and for costs.
[Or Applicant’s Solicitor,
To the Registrar of the County Court at
and to
and to Messrs.
[his [or their] solicitors].
Form 33.
Notice to Parties where the Question of Recording, a Memorandum of an Agreement is referred to the Judge under Schedule II., paragraph (8), proviso (d).
(a)
Take Notice that the Collector of Customs for the State of has refused to record the memorandum sent him in this matter for registration, and has referred the matter to the judge of the County Court pursuant to proviso (d) to paragraph 8 of the Second Schedule to the Act, it appearing to him that the said memorandum ought not to be registered by reason of—
(a) the inadequacy of the lump sum agreed to be paid in redemption of the weekly payment referred to in the memorandum: or
Form 33—continued.
(b) the inadequacy of the amount of compensation agreed to be paid to a person under legal disability: or
(c) the inadequacy of the amount of compensation agreed to be paid to and dependants: or
(d) the agreement having been agreed by fraud [or undue influence or improper means]
And further take notice, that by order of the judge you are hereby summoned to attend before him at on the day of at the hour of in the noon or so soon thereafter as the parties can be heard, when the matter will be inquired into.
And that if you do not attend either in person or by your solicitor on the day and the hour above-mentioned such order will be made and proceedings taken as the Judge thinks just and expedient.
Registrar of the County Court
at
To [all parties concerned].
Form 34.
Application for Removal of Record of Memorandum of Agreement from Register under Schedule II., paragraph (8), proviso (e).
(a)
Take Notice that I intend to apply to the judge of the County Court at on the day of at the hour of in the noon or so soon thereafter as the parties can be heard for an order for the removal from the register of the record of the memorandum of the agreement in the above-mentioned matter which was recorded on the day of pursuant to proviso (e) to paragraph 8 of the Second Schedule to the above-mentioned Act, on the ground that the said agreement was obtained by fraud [or undue influence or improper means] and for consequential directions, and for costs.
To the Registrar of the County Court at
and to
Messrs.
and his [or their] Solicitor.
Form 35.
Notice to Parties where Judge or Magistrate directs Inquiry as to Removal of Record of Memorandum of Agreement from Register under Schedule II., paragraph (8), proviso (e).
(a)
Whereas it has been made to appear to the judge of the County Court that an inquiry should be held as to the removal from the register of the record of the memorandum of the agreement in the above-mentioned matter which was recorded on the day of pursuant to proviso [e] to paragraph 8 of the Second Schedule to the above-mentioned Act, on the ground that the said agreement was obtained by fraud [or undue influence or improper means].
Take Notice that you are hereby summoned to attend before the judge at on the day of at the hour of in the noon or so soon thereafter as the parties can be heard, when the matter will be inquired into by him.
And that if you do not attend either in person or by your solicitor on the day and at the hour above-mentioned such order will be made and proceedings taken as the judge thinks just and expedient.
Registrar of the County Court
at
To [all parties concerned].
Form 36.
Application for Reference to Medical Referee under Schedule I, paragraph (13),
(a)
In the matter of a claim for compensation made by A.B.
of against the owners [or charterers] of the ship “ ”
[Or, where an arbitration is pending.]
In the matter of an arbitration between A.B.
and
the owners [or charterers] of the ship “ ”
Respondents,
[Or, where application is made after weekly payment has been settled.]
In the matter of an agreement [or a decision, or award] as to the weekly payment payable to A.B. of by the owners [or charterers] of the ship “ ”
Application is hereby made on behalf of the above-named A.B. and the owners [or charterers] of the ship “ ” for a reference in the above-mentioned matter to a medical referee pursuant to paragraph 13 of the First Schedule to the above-mentioned Act under the following circumstances:—
1. On the day of notice was given by [or on behalf of] the above-mentioned A.B. to the above-mentioned owners [or charterers] of personal injury caused to the said A.B. by accident arising out of and in the course of his employment in respect of which injury the said A.B. claims compensation from the said owners [or charterers] under the said Act.
[Or where arbitration is pending.]
1. An arbitration under the said Act is pending between the above-mentioned A.B. and the above-mentioned owners [or charterers] as to the amount of compensation payable to the said A.B. under the said Act in respect of personal injury caused to him by accident arising out of
[Or where weekly payment has been settled.]
1. Under an agreement [or a decision, or award] in the above-mentioned matter, recorded with the Collector of Customs at on the day of a weekly payment is payable to the above-mentioned A.B. by the above-mentioned owners [or charterers], as compensation in respect of personal injury caused to the said A.B . by accident arising out of and in course of his employment.
2. The weekly payment claimed by [or payable to] the said A.B. is
3. A question has [or questions have] arisen between the said A.B. and the said owners [or charterers], as to the condition [or fitness for employment] of the said A.B. [or as to whether [or to what extent] the incapacity of the said A.B. is due to the accident] [or as to the condition or fitness for employment] of the said A.B. and as to whether [or to what extent] the incapacity of the said A.B. is due to the accident, and no agreement can be come to between the said owners [or charterers] and the said A.B. with reference to such question [or questions].
4. The said A.B. has submitted himself for examination by a medical practitioner, provided by the said owners [or charterers] [or has been examined by a medical practitioner selected by himself] [or, if so, the said A.B. has submitted himself for examination by a medical practitioner provided by the said owners [or charterers], and has also been examined by medical practitioner selected by himself] and a copy of the report of the said practitioner is [or copies of the reports of the said practitioners are] annexed this application.
Form 36—continued.
The applicants request that an order may be made referring the matter to a medical referee for his certificate as to the condition of the said A.B. and his fitness for employment, specifying if necessary the kind of employment for which he is fit [or for his certificate whether [or to what extent] the incapacity of the said A.B. is due to the accident] [or for his certificate as to the condition of the said A.B. and his fitness for employment, specifying if necessary the kind of employment for which he is fit, and as to whether [or to what extent] the incapacity of the said A.B. is due to the accident.]
[Or Applicant’s Solicitor,
as representing the owners [or charterers]
of the ship “ ” ]
(Signature of managing owners or manager
or the master of the ship.)
[Or Solicitors for the owners
[or charterers.]
To the Collector of Customs for the
Form 37.
Order of Reference, Schedule I, paragraph (13).
On the application of A.B. of and the owners [or charterers] of the ship “ ” of (a copy of which is hereto annexed) I hereby appoint Mr. of one of the medical referees appointed for the purposes of the Seamen’s Compensation Act 1911 to examine the said [name of seaman] and to give his certificate as to the condition of the said and his fitness for employment, specifying if necessary the kind of employment for which he is fit, [or certificate whether [or to what extent] the incapacity of the said is due to the accident] [or his certificate as to the condition of the said and his fitness for employment, specifying if necessary the kind of employment for which he is fit, and as to whether [or to what extent] the incapacity of the said is due to the accident].
Copies of the reports of the medical practitioners by whom the said has been examined are hereto annexed.
The said who is now at has been directed to submit himself for examination by the referee.
I am satisfied that the said is in a fit condition to travel for the purpose of being examined, and he has been directed to attend on the referee for examination a such time and place as may be fixed by the referee.
[or The said does not appear to be in a fit condition to travel for the purpose of being examined.]
The referee is requested to forward his certificate to me on or before the day of
of
Form 38.
Order on Injured Seaman to submit himself for examination by Medical Referee.
To A.B. of [address and description.]
Take Notice that I have appointed Mr. of one of the medical referees for the purposes of the Seamen's Compensation Act 1911 to examine you in accordance with the application in the above-mentioned matter for a reference to a medical referee.
You are hereby required to submit yourself for examination by the referee [add where seaman is in a fit condition to travel, and to attend for that purpose at such time and place as may be fixed by him].
If you refuse to submit yourself for such examination or in any way obstruct the same your right to compensation and to take or prosecute any proceeding in relation to compensation (or your right to any weekly payment) shall be suspended until such examination has taken place.
of
Form 39.
Notice to Parties of Certificate of Medical Referee.
Take Notice that I have received the certificate of the medical referee appointed in this matter, and that you may inspect the same during office hours at my office situate at and may on request, and at your own cost, be furnished with or take a copy thereof.
of
To
and
Form 40.
Notice of Application for Suspension of Right to Compensation or to take or prosecute Proceedings in relation to Compensation, or of right to Weekly Payments, under Schedule I, paragraph (5), paragraph (11), or paragraph (13), and Regulation 55.
(a)
In the matter of a claim for compensation made by A.B.
of against the owners [or charterers] of the
ship “ ”
[Or where an arbitration is pending.]
A.B.
and
[Or, where application is made after weekly payment has been settled.]
In the matter of an agreement [or a decision or an award] as to the weekly payment payable to A.B. of by the owners [or charterers] of the ship “ ”
Form 40—continued.
Take Notice that I intend to apply to the judge at on the day of at the hour of in the noon or so soon thereafter as the parties can be heard (on behalf of the owners [or charterers] of the said ship) for an order suspending your right to compensation in the above-mentioned matter and to take or prosecute any proceedings under the above-mentioned Act in relation to compensation [or suspending your right to weekly payments in the above-mentioned matter] on the ground that you refuse to submit yourself to medical examination as required by me [or by the owners [or charterers] of the said ship] in accordance with paragraph (5) [or paragraph (11), of the First Schedule to the Act] [or that you obstruct the medical examination required by [or by the owners [or charterers] of the said ship] in accordance with paragraph (5) [or paragraph (11)] of the First Schedule to the Act] [or on the ground that you refuse to submit yourself for examination by a medical referee as ordered under paragraph 13 of the First Schedule to the Act] [or that you obstruct the examination by a medical referee ordered under paragraph 13 of the First Schedule to the Act] and for consequential directions, and for costs.
As representing the owners [or
charterers] of the ship.
[Signature of managing owners or
manager or of the master of the ship.]
To A.B. of
and to Messrs.
his Solicitors.
[Or
Solicitors for the said owners.
Form 41.
Notice to parties where the question of adequacy of amount paid to the prescribed authority under Regulation 57, is referred to the Judge.
In the matter of the Seamen’s Compensation Act 1911,
and
A.B.,
of, &c., &c.
and
Respondents,
or
In the matter of an agreement between
A.B.,
of, &c., &c.,
and
Take Notice that the question of the adequacy of the amount paid to the prescribed authority in this matter has been referred to the judge.
And Further Take Notice that by order of the judge you are hereby summoned to attend before the judge at on the day of at hour of in the noon, or so soon thereafter as the parties can be heard, when the matter will be inquired into by the judge; and that if you do not attend either in person or by your solicitor on the day and at the hour above-mentioned such order will be made and proceedings taken as the judge thinks just and expedient.
To [the employer and the persons appearing to be interested in the amount paid in].
Form 42.
Notice of Payment to the Prescribed Authority under Schedule I, paragraph (6).
(i)
(i) Where amount payable has been ascertained or decided and payment to the Prescribed Authority is made under Regulation 56.
Take Notice that the sum of has been paid to me as compensation in the above-mentioned matter.
Any person interested in the said sum may apply to the Comptroller-General of Customs for an order for the investment and application of the said sum for the benefit of the persons entitled thereto in accordance with paragraph 6 of the First Schedule to the Seamen’s Compensation Act 1911, and the Regulations made under the said Act.
of
To
Hours of attendance, &c.
(ii)
(ii) Where amount payable has not been ascertained or decided and payment is made under Regulation 57.
Take Notice that the sum of £ has been paid to me as compensation in the above-mentioned matter.
If any question arises as to the adequacy of the amount paid, or as to who are dependants, or as to the amount payable to each dependant or otherwise as to the application of the said sum, such question must be settled by arbitration in accordance with the above-mentioned Act and the Regulations made under the said Act.
If no question arises as to the adequacy of the amount paid, or as to who are dependants, or as to the amount payable to each dependant, any person interested in the said sum may apply to the Comptroller-General of Customs for an order for the investment and application of the said sum for the benefit of the persons entitled thereto in accordance with paragraph 6 of the First Schedule to the Seamen’s Compensation Act 1911, and the Regulations made under the said Act.
If no question arises as to the adequacy of the amount paid, or as to who are dependants, or as to the amount payable to each dependant, but any of the persons interested in the sum are absent or under disability, any person interested in the sum may apply to a judge for an order for the investment and application of the said sum for the benefit of the persons entitled thereto in accordance with paragraph 6 of the First Schedule to the Seamen’s Compensation Act 1911 and the Regulations made under the said Act.
of
To
Hours of attendance, &c.
Form 43.
Application for Investment or Application of Money paid to the prescribed authority under Schedule 1, paragraph (6.)
(1) Application to the Comptroller-General of Customs for Investment and Application of the Sum Paid to the Prescribed Authority.
Take Notice that I [name and address of applicant] intend to apply to the Comptroller-General of Customs at on the day of at the hour of in the noon or so soon thereafter as the parties can be heard, on behalf of myself and of [specify the persons on whose behalf the application is made] as dependants of the above-named A.B. for an order for the investment and application of the sum paid to the prescribed authority in the above-mentioned matter, and for the allotment of the same between the dependants of the said A.B.
To the best of my knowledge and belief the persons interested in the said sum as dependants of the said A.B. are
[State dependants, with their ages and relationship to deceased seaman, and places of residence.]
I intend to apply for an order for the investment and application of the said sum, and for the allotment of the same between the dependants of the said A.B. as follows, viz.:—
or in such other manner as the Comptroller-General of Customs in his discretion thinks fit for the benefit of the persons entitled thereto under the above-mentioned Act, and for consequential directions.
To the Registrar and [to any other parties interested where the application is made on behalf of some only of the parties interested].
2. Application to the Comptroller-General of Customs for Investment and Application of the Amount allotted to any person.
Take Notice that I [name and address of applicant] intend to apply to the Comptroller-General of Customs at on the day of at the hour of in the noon or so soon thereafter as the parties can be heard, on behalf of myself [or of ] for an order for the investment and application of the sum paid to the prescribed Authority in the above-mentioned matter and allotted to me [or to the said ]
I intend to apply for an order for the investment and application of the said sum as follows, viz.:—
or in such other manner as the Comptroller-General of Customs in his discretion thinks fit for my benefit [or for the benefit of the said ] and for consequential directions.
To the Comptroller-General of Customs.
Form 43—continued.
3. Application for Investment and Application of the amount paid to the prescribed authority where any of the persons interested in the sum is absent or under disability.
Take Notice that I [name and address of applicant] intend to apply to the judge at on the day of at the hour of in the noon or so soon thereafter as the parties can be heard, on behalf of myself and of [specify the persons on whose behalf the application is made] as dependants of the above-named A.B. for an order for the investment and application of the sum paid to the prescribed authority in the above-mentioned matter, and for the allotment of the same between the dependants of the said A.B.
To the best of my knowledge and belief the persons interested in the said sum as dependants of the said A.B. are [State dependants, with their ages and relationship to deceased seaman, and places of residence].
I intend to apply for an order for the investment and application of the said sum, and for the allotment of the same between the dependants of the said A. B. as follows, viz.:—
or in such other manner as the judge in his discretion thinks fit for the benefit of the persons entitled thereto under the above-mentioned Act, and for consequential directions.
To the Registrar and [to any other parties interested where the application is made on behalf of some only of the parties interested].
Form 44.
Application to Prescribed Authority for Variation of Award under Schedule I., paragraph (10).
Take Notice that I [name and address of applicant] intend to request the Collector of Customs for the State of on the day of at the hour of in the noon to make application to the judge of a County Court for an order that the order of the court [or the award made in the above-mentioned matter on the day of as to the apportionment of the sum paid as compensation among the dependants of A.B. deceased [or as to the manner in which the sum payable to a dependant of A.B. deceased, should be invested, applied, or otherwise dealt with] may be varied by directing [here state variation claimed by the applicant]:
And further take notice that the circumstances in which this application is made are [state particulars].
[or
[Applicant’s Solicitor
To the Collector of Customs for the State of
and to [all persons interested].
Form 45.
Application by Prescribed Authority for Variation of Order under Schedule I., paragraph (10).
Take Notice that I [name and address of applicant] intend to apply to the judge on the day of at the hour of in the noon or so soon thereafter as the parties can be heard, for an order that the order of the court [or the award] made in the above-mentioned matter on the day as to the apportionment of the sum paid as compensation among the dependants of A.B. deceased [or as to manner in which the sum payable to a dependant of A.B. deceased, should be invested, applied, or otherwise dealt with] may be varied by directing [here state variation claimed by applicant] and for consequential directions.
And further take notice that the circumstances in which this application is made are [state particulars].
of
To the Registrar of the County
and to [all persons interested].
Form 46.
Application by Seaman intending to cease to reside in Australia for Reference to Medical Referee under Schedule I., paragraph (19).
(a)
In the matter of the Seamen’s Compensation Act 1911
and
In the matter of an agreement [or a decision or an award] as to the weekly payment payable to A.B. of by the owners [or charterers] of the ship “ ”
Take Notice that A.B. of to whom under an agreement [or a decision or an award] in the above-mentioned matter recorded with the Collector of Customs for the State of on the day of a weekly payment of is payable by the above-mentioned owners [or charterers] of the ship “ ” as compensation for personal injury caused to the said A.B. by accident arising out of and in the course of his employment, intends to cease to reside in Australia;
And that the said A.B. intends to apply to the Collector of Customs at on the day of at the hour of in the noon or so soon thereafter as the parties can be heard, for an order referring to a medical referee the question whether the incapacity of the said A.B. resulting from the injury, is likely to be of a permanent nature.
A report of a medical practitioner, setting out the nature of the incapacity of the said A.B. resulting from the injury, is hereto annexed
[Or
Applicant’s Solicitor.]
and to [the employer].
Form 47
Order of Reference. Schedule 1, paragraph (19).
(a)
[Heading as in Application Form.]
On the application of of (a copy of which is hereto annexed), I hereby appoint Mr. of one the medical referees appointed for the purposes of the Seamen’s Compensation Act 1911, to examine the said [name of seaman] and to give his certificate as to whether the incapacity of the said [name of seaman] resulting from the injury is likely to be of a permanent nature.
A copy [or copies] of the report [or reports] of the medical practitioner [or practitioners] by whom the said has been examined, is [or are hereto annexed. [Add, if so: Copies of the statements submitted to me by the parties are also hereto annexed].
The said who is now at has been directed to submit himself for examination by the referee.
I am satisfied that the said is in a fit condition to travel for the purpose of being examined, and he has been directed to attend on the referee for examination at such time and place as may be fixed by the referee.
[Or, The said does not appear to be in a fit condition to travel for the purpose of being examined.]
The referee is requested to forward his certificate to the Collector of Customs at on or before the day of specifying therein the nature of the incapacity of the said resulting from the injury, and whether such incapacity is likely to be of a permanent nature.
Judge [or Collector of Customs].
Form 48.
[To be printed on thick blue foolscap.]
Certificate of Identity.
[To be carefully preserved.]
Notice.—This Certificate is no security whatever for a debt.
No. of Certificate.
(a)
This is to Certify that A.B. late of [address and description is entitled to a weekly payment of from [name and address of employer] as compensation payable to the said A.B. in respect of personal injury caused to him by accident arising out of and in the course of his employment, such weekly payment to continue during the total or partial incapacity of the said A.B. for work; and that the description of the said A.B. and his incapacity for work, as certified by the medical referee appointed in this matter, are as follows:—
Age
Height
Hair Eyes
Nature of incapacity
[Describe nature of incapacity, as in certificate of medical referee.]
Form 49.
Notice to be given to Seaman intending to cease to reside in Australia.
Take Notice, that if you desire to obtain payment of the weekly payment payable to you under the award [or memorandum] hereto annexed while you are residing out of Australia, you must at intervals of three months from the date up to which such payments have been made submit yourself to examination by a medical practitioner in the place where you are residing, and produce to him the copy of the certificate of the medical referee and the certificate of identity hereto annexed; and you must obtain from such medical practitioner a certificate in the form hereto annexed that he has examined you, and that your incapacity resulting from the injury specified in the certificate of the medical referee continues: and such certificate must be verified by the medical practitioner by declaration in your presence before some person as hereinafter mentioned.
You must also attend before some such person as hereinafter mentioned, and make a declaration in the form hereto annexed that you are the same person as mentioned in the copy of the certificate of the medical referee and in the certificate of identity hereto annexed, and in the certificate of the medical practitioner by whom you have been examined, producing to such person the copy and certificates, above mentioned.
You must then transmit to me, at my office, situate at , the certificate of the medical practitioner by whom you have been examined, and your declaration, together with a request for transmission to you of the amount of the weekly payment due to you, specifying the place where and the manner in which the amount is to be transmitted, according to the form hereto annexed, which request must be signed in your own handwriting.
The persons before whom a certificate may be verified or a declaration made are:—
1. Any person having authority to administer an oath in the place in which you reside.
2. Any British ambassador, envoy, minister, charge d’affaires, or secretary of embassy or legation, exercising his functions in any foreign place in which you reside, or any British consul-general, consul, vice-consul, acting-consul, pro-consul, or consular agent exercising his functions in any foreign place in which you reside. In the event of your death while residing out of Australia, your representatives must, in order to obtain payment of the arrears due to you transmit to me at my office, situate at a certificate of your death and documents showing that they are entitled to such arrears, verified by declaration before a person having authority to administer an oath, with a request for transmission to them of the amount of such arrears, specifying the place where and the manner in which such amount is to be transmitted to them.
The expression “your representatives” means—
(a) if you leave a will, the executors of such will; or
(b) if you die intestate, the persons who are according to law entitled to your personal estate; and payment of the arrears may be made to such persons without the production of letters of administration.
of [address and description]
Form 50.
Form of Medical Certificate to be obtained by Seaman residing out of Australia.
I [name, address, and medical qualification of medical practitioner]
hereby certify that I have this day examined A.B. of whom I conscientiously believe to be the same person as A.B. of described in the copy certificate of the medical referee in the above-mentioned matter, dated the day of and in the certificate of identity
Form 50—continued.
dated the day of produced to me by the said A.B. and that in my opinion the incapacity of the said A.B. resulting from the injury described in the said certificate of the medical referee still continues.
(Signature)
Declared at this day of in the presence of the said A.B. the copy of the certificate of the medical referee and the certificate of identity above-mentioned being at the same time produced.
Before me—
[Signature and description of persons before whom the declaration is made.]
Form 51.
Declaration of Identity by Seaman Residing out of Australia.
I, A.B. of hereby declare that I am the same person as A.B. of described in the copy of the certificate of the medical referee in the above-mentioned matter, dated the day of now produced by me, and in the certificate of identity, dated the day of now produced by me, and the same person as A.B. of described in the certificate of declared by the said in my presence on the day of and now produced by me.
A.B.
Declared at this day of the certificates above-mentioned being at the same time produced.
Before me—
[Signature and description of person before whom the declaration is made.]
Form 52.
Request for Transmission of Amount of Weekly Payments by Seaman residing out of Australia.
Sir,—
I herewith enclose medical certificate and affidavit of identity, and request that the amount of the weekly payments due to me in the above-mentioned matter may be transmitted to me at
[give full address]
[state how transmission to be made, as]
by Post Office Order payable at
[name of Post Office]
or by bankers’ draft on the
[name and address of Bank]
I am, Sir,
Your obedient Servant,
A.B.
[To be signed by the Seaman in his own handwriting.]
[add address of Collector’s office.]
Form 53.
Notice by the prescribed authority to Employer of Receipt of Medical Certificate and Declaration of Identity.
Take Notice, that I have received proof of identity and of continuance of incapacity in the above-mentioned matter.
And I have to request you to transmit the sum of being the amount of the weekly payments payable to A.B. under the above-mentioned award [or memorandum] from [the date to which they were last paid ] to [13 weeks from that date] to me, to be by me remitted to the said A.B.
To [name and address of employer.]
Form 54.
Execution on Award or Memorandum.
Whereas on the day of an award was made in the above-mentioned matter by the judge [or by Mr. an arbitrator appointed by the judge] whereby it was ordered [state operative parts of award]—
[Or, Whereas on the day of a memorandum was recorded with the Collector of Customs for the State of of an agreement [or a decision, or an award] come to [or given or made] in the above-mentioned matter, whereby it was agreed [or ordered] [state operative parts of agreement, decision, or award]—
And whereas default has been made in payment of the sum of £ payable by the said to the prescribed authority [or to the said A.B. according to the said award [or memorandum];
These are therefore to require and order you forthwith to make and levy by distress and sale of the goods and chattels of [name the party against whose goods execution is issued] wheresoever they may be found within the district of this Court (except the wearing apparel and bedding of him or his family), and the tools and implements of his trade, if any, to the value of Ten pounds), the sum stated at the foot of this warrant, being the amount due under the said award [or memorandum], together with the costs of this execution; and also to seize and take any money or bank notes and any cheques, bills of exchange, promissory notes, bonds, specialties, or securities for money of the said which may there be found, or such part or so much thereof as may be sufficient to satisfy this execution, and the costs of making and executing the same, and to pay what you shall have so levied to the Registrar of this court, and to make return of what you have done under this warrant immediately upon the execution thereof.
Given under the seal of the court this day of 19
By the court,
Registrar,
To the Bailiff of the said court,
£
s.
d.
Amount in payment whereof default has been made...............
Poundage for issuing this warrant..........................
Total amount to be levied (with fees for execution of warrant, as indorsed hereon)
[See Back.]
[Back to be indorsed in form adopted in County Court writs.]
Form 55.
Judgment Summons.
Whereas on the day of an award was made in the above-mentioned matter by the judge [or by Mr. an arbitrator appointed by the judge] whereby it was ordered [state operative parts of award]:
[or Whereas on the day of a memorandum was recorded with the Collector of Customs for the State of of an agreement [or a decision or an award] come to [or given or made] in the above-mentioned matter whereby it was agreed [or ordered] [state operative parts of agreement, decision, or award]:
And whereas default has been made in payment of the sum of £ payable by you the above-named to the prescribed authority [or to the said A.B. ] according to the said award [or memorandum]:
These are therefore to require you to appear personally before the said court on the day of 191 at o’clock in the noon to be examined by the said court touching your estate and effects, and as to the property and means you have of paying the said sum together with interest thereon, and [if there have been previous fruitless executions] the costs of previous executions against you, and as to the disposal you have made of your property and the mode in which you incurred the liability; and if you disobey this summons you will be committed to prison.
Given under my hand and the seal of the said court this day of
Registrar of the said court.
Form 56.
Notice by Medical Referee to Employer or Solicitor signing the Application on Employer’s behalf: Schedule I., par. (13).
To
I hereby give you notice that in accordance with the Reference made to me by the Collector of Customs for the State of under Schedule I., paragraph (13), of the above-named Act, in the case of [name and address of worker] I propose to examine the said at on the day of at o’clock.
Any statements made or submitted by you [or if notice is addressed to the solicitor, by the employer], will be considered.
Form 57.
Notice by Medical Referee to Seaman or Solicitor signing the Application on Seaman's behalf: Schedule I., par. (13).
To
I hereby give you notice that in accordance with the reference made to me in your case [or, if notice is addressed to the solicitor], in the case of [name and address of seaman] by the Collector of Customs for the State of , under Schedule I., paragraph (13), of the above-named Act, I propose to examine you [or the said ] at on the day of at o’clock.
And you are required to submit yourself [or the said is required to submit himself] for examination accordingly.
Any statements made or submitted by you [or, if notice is addressed, to the solicitor, by the worker] will be considered.
Form 58.
Certificate of Medical Referee as to Condition of Seaman and fitness for employment, or as to whether or to what extent Incapacity of Seaman is due to the Accident: Schedule I., paras. (13) and (15).
In accordance with the Reference made to me by the Collector of Customs for the State of upon the application of [names and addresses of parties] I have on the day of examined the said [name of seaman] and I hereby certify as follows:—
*Describe state of health.
†State whether seaman is fit for his ordinary or other work, specifying where necessary the kind of work, whether he is unfit for work of any kind.
‡State whether or to what extent the incapacity is due to the accident.
1. The said is*
and his condition is such that he is†
2. The incapacity of the said is ‡
Note.—Either paragraph 1 or paragraph 2 to be filled up, or both to be filled up, according to the terms of the Reference.
Form 59.
Notice by Medical Referee to Seaman: Schedule I., par. (19).
To
I hereby give you notice that in accordance with the Reference made to me in your case by the Collector of Customs at under Schedule I., paragraph (19), of the above-named Act, I propose to examine you at on the day of at o’clock and you are required to submit yourself for examination accordingly.
Form 60.
Certificate of Medical Referee: Schedule I., par. (19).
In accordance with the Reference made to me by the Collector of Customs at under Schedule I., paragraph (19), of the above-named Act, I have on the day of examined of [name and address of worker] and I hereby certify that his incapacity is [or is not] likely to be of a permanent nature.
Form 61.
Reference to a Medical Referee under Schedule II., para. (12).
In the matter of an arbitration between—
A.B.
and
We, a committee, representative of the owners, [or charterers] of the ship “ ” and their seamen, and empowered to arbitrate in the matter arising under the Seamen’s Compensation Act 1911 between them:
[or I , an arbitrator agreed upon by the above-named parties to arbitrate in the matter arising between them under the Seamen’s Compensation Act 1911]:
[or I, , a judge of a County Court]:
[or I, , arbitrator appointed by , a judge of a County Court], having heard the evidence tendered by both parties, hereby certify that in our [or my] opinion the medical evidence given before us [or me] is conflicting [or insufficient] on a matter which seems to us [or me] to be material to a question arising in the above-mentioned arbitration, and that it is desirable to obtain a report from a medical referee on such matter, as follows:—
(a) On the day of personal injury was [or is alleged to have been] caused to of by accident arising out of and in the course of his employment, under the following circumstances:
[Here state the facts of the accident as ascertained from the evidence]
(b) The matter on which we are [or I am] satisfied that it is desirable to obtain a report is:
[Here state the matter on which report is desired.]
(c) The matter seems to be material to the following question arising in the arbitration, viz.:
[Here state the question to which the matter is material.]
We [or I] therefore appoint one of the medical referees appointed for the purposes of the Seamen’s Compensation Act 1911 to examine the said on the matter specified above, and to report to us [or me].
A statement of the medical evidence given before us [or me] is appended.
We are [or I am] satisfied that the said who is now at is in a fit condition to travel for the purpose of being examined, and he has been directed to attend on the referee for examination at such time and place as shall be fixed by the referee [or does not appear to be in a fit condition to travel for the purpose of being examined].
The referee is requested to forward his report to the Registrar of the County Court of on or before the day of
Judge or Arbitrator
On behalf of the Committee, Chairman of Secretary Committee
Signature of Registrar
and Seal of Court.
A previous Reference was made to a medical referee in this case on the day of and a copy of the report then given is attached.
Form 62.
Order on Injured Seaman to submit himself for examination by Medical Referee.
[Title as in Reference.]
That the Committee [or arbitrator, or judge] have [or has] appointed one of the medical referees under the Seamen’s Compensation Act 1911 to examine you for the purposes of the above-mentioned arbitration, and to report to them [or him].
You are hereby required to submit yourself for examination by such referee (and to attend) for that purpose at such time and place as may be fixed by him.
[To be signed in the same manner as Reference.]
Form 63.
Notice by Medical Referee to injured Seaman: Schedule II, par. (12).
I hereby give you notice that I have been appointed to examine and report on your case under paragraph 12 of the Second Schedule of the Seamen’s Compensation Act 1911, and that I propose to make such examination at on the day of at o’clock.
Form 64.
Medical Referee’s Statement of Fees in respect of References under Schedule I., paragraph (13).
Total £
Endorsement to be made on back of Statement.
I hereby certify that I examined the seaman on at which is distant miles from my residence [or Prescribed centre].
Form 65.
Medical Referee’s Statement of Fees in respect of References under Schedule I., paragraph (19).
Form 66.
Medical Referee’s Statement of Fees in respect of References under Schedule II., paragraph (12).
Form 67.
Record of References, &c., to be kept by the Registrar and the Prescribed Authority.
For quarter ended
Number of Reference.
Names of Parties.
Date on which Reference forwarded to Medical Referee.
Provision in the Act under which Reference is made, and if under Schedule II.) par. 12, by Whom Made.*
Whether Seaman directed to attend a Referee or not.
Medical Referee Appointed.
Date and Number of Previous Reference in same case (if any).
* Here say whether committee, agreed arbitrator, County Court judge, or appointed arbitrator.
_____________________
Printed and Published for the Government of the Commonwealth of Australia by Albert J. Mullett, Government Printer for the State of Victoria.