MAR. 6.] THE NEW ZEALAND GAZETTE. 729

SCHEDULE.
FORMS.

No. 1. General Heading for all Written Proceedings in an Action.
New Zealand. No.
In the Court of Arbitration, [Northern] Industrial District.
Between A. B.,
Plaintiff,
and C. D.,
Defendant.

No. 2. General Heading for all Written Proceedings not in an Action.
New Zealand.
In the Court of Arbitration, [Northern] Industrial District.
In the matter of the Workers' Compensation
Act, 1908;
and
In the matter of a claim for compensation
against A. B., of , in respect of the
death of [or of injuries suffered by] C. D.,
of .

No. 3. Writ of Summons.
You are hereby summoned to attend the Court of Arbitration at a time and place to be hereafter
appointed by the Judge of that Court in that behalf to answer a claim made by the plaintiff under
the Workers’ Compensation Act, 1908, particulars of which are hereunto annexed.
And take notice that unless within fourteen days from but exclusive of the day of the service
of this writ you file in the office of the Clerk of Awards at [e.g., Wellington] a statement of your
defence to the plaintiff’s claim you will not be permitted to defend the action except with the leave
of the Court, and the plaintiff may proceed in his action without further notice to you.
Dated at , this day of , 19 .
To the above-named defendant, C. D. (Seal.)
This writ is sued out by the plaintiff in person [or by , solicitor for the plaintiff],
whose address for service is .
(See indorsements on the back of this writ.)

INDORSEMENTS.
This writ must be served on you within four months from the date thereof or from the date
of renewal, if renewed.
If the last day for delivering your statement of defence falls on a Sunday or a day on which
the office of the Clerk of Awards is closed, the statement may be delivered on the next succeeding
day on which that office is open.
If you confess the plaintiff's claim or any part thereof, you should sign and deliver your
confession to the Clerk of Awards before the expiration of the time limited for filing your statement
of defence; but you may deliver your confession at any time before the trial, subject to the
payment of any further costs which your delay has caused the plaintiff to incur.
Summonses to secure the attendance of witnesses will be issued on application at the office
of the Clerk of Awards.
If you duly file your statement of defence, notice of the day and place fixed for the trial of
the action will be subsequently given to you by the Clerk of Awards.
The office of the Clerk of Awards is situated at [e.g., the Supreme Court Buildings, Wellington.]

No. 4. Warrant to sue or defend.
I hereby authorise you to appear and act as my solicitor in an action brought by me under
the Workers' Compensation Act, 1908, against .
Dated this day of , 19 .
Name:
Address:
Calling:

No. 5. Affidavit of Service.
I, , of , in the Dominion of New Zealand, make oath and say,—
That I did on the day of , 19 , serve the above-named defendant
with a writ of summons and statement of claim, true copies of which are hereunto annexed and
marked A and B, at , in the Provincial District of , in New Zealand, by delivering
the same personally to the defendant [Or as the case may be].