MAY 16.] THE NEW ZEALAND GAZETTE. 1065

weekly payment to commence as from the day of
, 19 , and to continue during the total or partial
incapacity of the said A.B., or until the same is ended,
diminished, increased, or redeemed, in accordance with the
provisions of the Act ;
And for payment by them to the said A. B. forthwith after
the award of the amount of such weekly payments, calcu-
lated from the day of until the first Satur-
day [or other usual pay-day] after the date of the award,
and for the payment thereafter of the said sum of to
the said A. B. on Saturday [or other usual pay-day] in every
week.
[Or, And the said C. D. and Co. herewith pay into Court
the sum of £ in satisfaction of such liability.]
Dated this day of , 19 .
(Signed) . . . . . . . . . . . . . . . . . . .
Solicitors for the Respondents,
C. D. and Co.
To the Clerk of Awards, and to the claimant, A. B.,
and to the respondents [if any, naming them].

(Form 9. Reg. 15.)
NOTICE OF FILING SUBMISSION TO AN AWARD.
[Heading as in Form 1.]
TAKE notice that the respondents, C. D. and Co., 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 pay-
ment 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 me and to the said C. D. and
Co. a written notice by post, or leave such notice at my
office, and at the residence or place of business of the said
C. D. and Co.
If you send such notice, the Court will, on application,
make an award directing payment of such weekly sum to
you, and you will be liable for no further costs.
If you do not send such notice, the arbitration will be
proceeded with ; and if no greater weekly payment is awarded
to you, you will be liable to be ordered to pay the costs in-
curred by the respondents subsequent to the receipt by you
of this notice.
Dated this day of .19 , Clerk of Awards.
To the claimant, A. B.

(Form 10. Reg. 15.)
NOTICE OF PAYMENT INTO COURT.
[Heading as in Form 1.]
TAKE notice that the respondents, C. D. and Co., 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 Court the 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-men-
tioned matter, you must send to me, and to the said C. D.
and Co. and to the other respondents [or, where this notice
is sent to a respondent, to the claimant and the other re-
spondents] a written notice forthwith by post, or leave such
notice at my office, and at the residence or place of business
of the said C. D. and Co., and at the residence or place of
business of each of the other respondents [or, of the claimant
and each of the other respondents].
If you and all the other respondents [or, If you and the
claimant and all the other respondents] send such notice,
and agree as to the apportionment and application of the
said sum of £ , the Court will, on application, 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
claimant 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 as between you and such other respondents [or, as
between the claimant and yourself and such other re-
spondents].
If such notice is not sent by you and all the other re-
spondents [or by the claimant 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, C. D. and Co., 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 com-
pensation payable in the above-mentioned matter.
Dated this day of , 19 , Clerk of Awards.
To the claimant, A. B. [or To the respondent, G. H.,
or as the case may be].

(Form 11. Regs. 16, 17.)
ACCEPTANCE OF WEEKLY SUM OFFERED OR OF SUM PAID
INTO COURT.
[Heading as in Form 1.]
TAKE notice that the claimant, A. B., accepts the weekly
sum offered by the respondents, C. D. and Co., in satisfac-
tion of his claim in the above-mentioned matter [or that
the claimant, E. F., (or the respondent, G. H.) is willing to
accept the sum of £ paid into Court by the respond-
ents, C. D. and Co., in satisfaction of the compensation
payable in the above-mentioned matter].
But the claimant [or the respondent, G. H.] will apply to
the Court to include in its award an order directing the re-
spondents, C. D. and Co., to pay the costs properly incurred
by the claimant [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].
Dated this day of , 19 .
(Signed) . . . . . . . . . . . . . . . . . . .
Claimant
[or Respondent].
To the Clerk of Awards, and to the respond-
ents, C. D. and Co., and to the claimant,
A. B., and to the respondents [naming
them, as the case may be].

(Form 12. Reg. 22.
AWARD IN CASE OF APPLICATION BY WORKER.
[Heading as in Form 1.]
HAVING duly considered the matter submitted to us, we do
hereby make our award as follows :—

1. We order that the respondents, C. D. and Co., do pay to
   the claimant, A. B., the weekly sum of as compen-
   sation for personal injury caused to the said A. B. on the
   day of by accident arising out of and in
   course of his employment as a worker employed by the said
   C. D. and Co. in [State nature of employment], such weekly
   payment to commence as from the day of ,
   and to continue during the total or partial incapacity for
   work of the said A. B., or until the same is ended, dimi-
   nished, increased, or redeemed in accordance with the pro-
   visions of the Act.
2. And we order that the said C. D. and Co. 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 [the first Saturday
   or other usual pay-day after the date of the award], and do
   thereafter pay the said sum of to the said A. B. on
   Saturday [or other usual pay-day] in every week.
3. And we order that the said C. D. and Co. do, within
   fourteen days from the date hereof, pay to the Clerk of
   Awards, for the use of the claimant, his costs of and inci-
   dent to this arbitration, which we assess at the sum of £ .
   Dated this day of , 19 . , President.

(Form 13. Reg. 22.)
AWARD IN CASE OF APPLICATION BY DEPENDANTS.
[Heading as in Form 1.]
HAVING duly considered the matters submitted to us, we do
hereby make our award as follows :—

1. We order that the respondents, C. D. and Co., 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 course of his employment as a worker
   employed by the said C. D. and Co. in [State nature of em-
   ployment].
2. And we declare that the persons hereinafter named are
   entitled to share in such compensation as dependants of the
   said A. B.—that is to say, I. B., the widow of the said A. B.,
   and K. B. and L. B., daughters of the said A. B. under the
   age of twenty-one years.
3. And we declare that the respondent, G. B., the father
   of the said A. B., is not entitled to share in such compensa-
   tion as a dependant of the said A. B.
4. And we order that the said sum of £ be appor-
   tioned between the said I. B., K. B., and L. B. in the fol-
   lowing proportions :—
   To or for the benefit of the said I. B., the sum of £ ;
   To or for the benefit of the said K. B., the sum of £ ;
   and
   To or for the benefit of the said L. B., the sum of £ .
5. And we order that the said C. D. and Co., within four-
   teen days from the date hereof, do pay the said sum of £
   to the claimant, E. F., the legal personal representa-
   tive of the said A. B. [or, if no legal personal representative,