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

Form O
[See rules 49 and 50]
Take notice that registration of the agreement to pay compensation said to have been reached between you…………and ………………on the………………20………………has been refused for the following reasons, namely:
……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ………………………………………………………………
Dated………………20…….. Commissioner