✨ Court Forms
732
THE NEW ZEALAND GAZETTE
No. 19
No. 15. Certificate to be filed in Court of Arbitration.
In the Supreme Court of New Zealand,
District.
Between A. B., of [Address and description], plaintiff,
and
C. D., of [Address and description], defendant.
And in the matter of the Workers' Compensation Act, 1908.
I hereby certify that on the day of , the above-named plaintiff commenced an
action against the above-named defendant [Here state claim of plaintiff]:
And that on the trial of the action before me on the day of it was determined
that the injury in respect of which the plaintiff claimed damages was one for which the defendant
was not liable in the action, but that the defendant would have been liable to pay compensation in
respect of that injury under the above-mentioned Act:
And that therefore the action was dismissed, but the Court, on the request of the plaintiff,
proceeded to assess the compensation which the defendant would have been liable to pay under the
said Act:
And that the Court assessed such compensation at the sum of , and directed [State
directions given as to the payment of compensation and costs, and directions (if any) as to the
deduction of costs from compensation, or as to any other matters].
Dated this day of , 19
(Seal of the Supreme Court.)
(Signature of Judge.)
J. HISLOP,
Acting Clerk of the Executive Council.
By Authority : JOHN MACKAY, Government Printer, Wellington.—1909
NZ Gazette 1909, No 19
✨ LLM interpretation of page content
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Certificate to be filed in Court of Arbitration for Workers' Compensation Act
(continued from previous page)
⚖️ Justice & Law EnforcementCourt of Arbitration, Workers' Compensation Act, Supreme Court, Plaintiff, Defendant, Damages, Compensation, Costs, Certificate
- J. Hislop, Acting Clerk of the Executive Council