Workmen's Compensation Act, 1923
22. Form of application
(1) Where an accident occurs in respect of which liability to
pay compensation under this Act arises a claim for such compensation may
subject to the provisions of this Act be made before the Commissioner,
(1A) Subject to the provisions of sub-section (1) no application
for the settlement of any matter of Commissioner other than an application by a
dependant or dependants for compensation shall be made unless and until some
question has arisen between the parties in connection therewith which they have
been unable to settle by agreement.
(2) An application to a Commissioner may be made in such form
and shall be accompanied by such fee if any as may be prescribed and shall
contain in addition to any particulars which may be prescribed the following
particulars namely :-
(a) A concise statement of the circumstances
in which the application is made and the relief or order which the applicant
claims;
(b) in the case of a claim for compensation
against an employer the date of service of notice of the accident on the
employer and if such notice has not been served or has not been served in due
time the reason for such omission;
(c) the names and addresses of the parties;
and
(d) except in the case of an application by
dependants for compensation a concise statement of the matters on which
agreement has and of those on which agreement has not been come to.
(3) If the applicant is illiterate or for any other reason is
unable to furnish the required information in writing the application shall if
the applicant so desires be prepared under the direction of the Commissioner.