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Group Title: Antigua, Montserrat and Virgin Islands gazette.
Title: The Antigua, Montserrat and Virgin Islands gazette
ALL VOLUMES CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00076853/00179
 Material Information
Title: The Antigua, Montserrat and Virgin Islands gazette
Physical Description: 12 v. : ; 25-35 cm.
Language: English
Creator: Antigua
Montserrat
British Virgin Islands
Publisher: Govt. Printer.
Place of Publication: St. John's? Antigua
Frequency: weekly
completely irregular
 Subjects
Subject: Law -- Periodicals -- Antigua and Barbuda   ( lcsh )
Law -- Periodicals -- Montserrat   ( lcsh )
Law -- Periodicals -- British Virgin Islands   ( lcsh )
Politics and government -- Periodicals -- Antigua and Barbuda   ( lcsh )
Politics and government -- Periodicals -- Montserrat   ( lcsh )
Politics and government -- Periodicals -- British Virgin Islands   ( lcsh )
Genre: federal government publication   ( marcgt )
legislation   ( marcgt )
periodical   ( marcgt )
 Notes
Dates or Sequential Designation: v. 1-12, no. 18; July 5, 1956-Mar. 30, 1967.
General Note: Includes supplements consisting of bills, ordinances, statutory rules & orders, etc.
 Record Information
Bibliographic ID: UF00076853
Volume ID: VID00179
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: aleph - 001667609
oclc - 17270322
notis - AHX9420
lccn - 58045856
 Related Items
Preceded by: Leeward Islands gazette
Succeeded by: Antigua official gazette
Succeeded by: Montserrat official gazette
Succeeded by: Virgin Islands official gazette

Table of Contents
    Main
        Page 127
        Page 128
        Page 129
        Page 130
    Antigua, Statutory Rules and Orders, no. 28 of 1959: Proclamation dated July 28, 1959, bringing into operation the Beach Control Ordinance 1958 (No. 6 of 1958)
        Page A-1
    Montserrat, Statutory Rules and Orders, no. 35 of 1958: Workmen's Compensation Regulations, 1958
        Page B-1
        Page B-2
        Page B-3
        Page B-4
        Page B-5
        Page B-6
        Page B-7
        Page B-8
        Page B-9
        B-10
        B-11
        Page B-12
        Page B-13
        B-14
        B-15
        Page B-16
        Page B-17
        Page B-18
        Page B-19
        Page B-20
        Page B-21
        Page B-22
        Page B-23
        Page B-24
        Page B-25
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        Page B-27
        Page B-28
        Page B-29
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        Page B-31
        Page B-32
        Page B-33
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Full Text





THE

SANTIGUA, MONTSERRAT\

AND 3.P \c3S

VIRGIN ISLANDS G ZETTE.

Published by cUuthorit 9

VOL. IV. THURSDAY, 6TH AUGUST, 1959. No. 37.


Notices.


The attention of the general public
is drawn to the provisions of The
West Indies Publications Regulations,
1958, No. 2 of 1958, and particularly
to Regulation No. 3 which requires
that within one month after publica-
tion one copy of each publication
printed in The West Indies is to be
rnpplied to the Federal Library in
Trinidad through the Federal Secre-
tary, and to the Lib)rary of the
University Coilege of the West Indies
Administrator's Office,
Antigua.
1st August. 1959.
Ref.No. A. 6)A/131.

It is notified for general informa-
tion that the Administrator has been
pleased to cancel the appointment of
GEORGE MATHIAS ROBERTS as an
Immigration Officer assisting t h e
Officer in Charge of the Treasury in
the performance of his duty as Immi-
gration Officer, and has, under section
3(1) of the Immigration and Passport
Act, 1945 appointed the said GEORGE
MATHIAS ROBERTS, d u r in g Her
Majesty's pleasure to be an Immigra-
tion Officer with effect from the 27th
day of July, 1959.
Administrator's Office,
Road Town, Tortola,
British Virgin Islands,
28th July, 1959.


THE GOVERNOR-IN-COUNCIL
has been pleased to appoint
HENRY OSMOND CREQUE
with effect from the 26th day of June
1957 (No. 4 of 1957) to be the
Authorized Officer during the absence
from the Colony on study leave of
RALPH TELFORD O'NEAL, for the
purpose of the acquisition of the Sage
Mountain Fo res t area, containing
approximately 99 acres and situated
at Sage Mountain Forest in the island
of Tortola.
Dated the 23rd day of July, 1959.
B. ABBOTT,
Clerk of the Executive Council.

Administrator's Offie,
Tortola,
British Virgin Islands.


THE GOVERNOR-IN-COUNCIL
las been pleased to appoint GEORGE
ELWIN ULRIC DAWSON, Acting
Superintendent of Agriculture, with
effect from the 24;h day of July,
1959, under section 2 of the Land
Acquisition Ordinance, 1957 (No. 4
of 1957) to be the authorized officer
for the purpose of the acquisition of
that area of land containing approxi-
mately 183 acres situate at Paraquita
Bay and known as Paraquita Bay
Estate.
Dated this 23rd day of July, 1959.
B. ABBOTT,
Clerk of the Executive Council.

Administrator's Office,
Road Town, Tortola,
British Virgin Islands.
30th July, 1959.
Ref. No. 1/43.

No. 65.
The following Statutory Rules and
Orders are circulated with this Gazelte
and form part thereof:-

Antigua.
No. 28 of 1959, "Proclamation
dated July 28, 1959, bringing into
operation the Beach Control Or-
dinance 1958 (No. 6 of 1958).
1 pp. Price 5 cts.
Montserrat.
No. 35 of 1958, "The Workmen's
Compensation Regulations, 1958. "
55 pp.

INCOME TAX.
All persons who claim a deduction
under the Income Tax Ordinanct for
reliefs in respect of Wife, Children,
Dependent Relatives, Life Insurance
are reminded that such claims must
be made on the prescribed f o r m.
These forms can i h obtained at the
Income Tix Office, High Street.
'The Ordinance provides for penal-
ties for any person who wilfully fails
to comply with the provisions of the
appropriate section.
Those members of the public who
have not submitted returns for 1959
whose total annual income exceeds
Five hundred dollars ($500) should
supply returns not later than the 15th
August, 1959, after which date pro-
ceedings may be commenced without
further warning.
E. G. O. BERRIDGE,
Commissioner of Income Tax.


POST OF STUDENT X-RAY
TECHNICIAN.


Applications are invited for the
post of Student X-ray Technician,
Holberton Hospital.
The salary of the post is $950.40
per annum in the scale $950.40x43.20
-1123.20x57.60-1238.40.
The successful candidate will be
required to assist the Radiographer
in developing X-ray films and such
other duties as the Senior Medical
Officer may direct.
Candidates should be in possession
of the Cambridge School Certificate
or its equivalent. A practical know-
ledge of photography is desired but
is not essential.
Candidates should apply in writing
to the Medical Superintendent, Hol-
berton Hospital, not later than 15th
August, 1959. Their applications
should give full particulars including
age and should be accompanied by
the necessary School Certificate and
two testimonials of good character.

Administrator's Ofice,
Antigua.
July, 1959.


TENDER NOTICE.


Tenders are invited for the pur-
chase of an old Pick-up truck No
A.G. 1048 which may be inspected in
the yard of the Education Office.
2. Tenders should be in seal e'd
envelopes marked "TENDER FOR
PICK--UP A.G. 1048" and address-
ed to the Chairman, Tenders Commit-
tee c/o Administration Building, St.
.John's and should reach that build-
ing not later than noon on Saturday
8th August, 1959.
3 Government does not bind
itself to accept the highest or any
tender.

Administrator's Office,
St. John's,
Antigua.
23rd July, 1959.
Ref. No. A. 66/31.


1, 2~ Q..









THE ANTIGUA, MONTSERBAT & VIRGIN ISLANDS GAZ'ET12 E.


TRADE MARKS OFFICE,
MONTSERRAT llth July, 1959.

FEDERATED PHARMACUETI-
CAL CO. LTD. of :;} Harbour
Street, Kington, Jamaica have ap-
plied for Rt-gistration of one Trade
Mark consistiig of the following:


in Class 2-Chemical substances used
for veterinary and sanitary purposes.

Class 3-Pharrrmceutical p r o d u c t s,
Medicinals and antibiotics.

The Applicants c 1 aim that they
have not used the said Trade Mark in
respect of the said goods in Montser-
rat before the date of their said
Application.

Any person may within three
months from the date of the first
appearance of this Advertisement in
the Antigua Montserrat & Virgin
Islards Gazette give notice in du-
plicate at the Trade Marks Office,
Montserrat, of opposition of the said
Trade Mark.
D. F. JOHNSON.
Ag. Registrar of Trade Marks.


TRAI)E MARKS OFFICE,
MONTSERRAT, 18th July, 1959.

COLUMBIA I'ICTURES CORPO-
1RATION of 711 Fifth Avenue, New
York, Stat- of New York United
States of America have applied for
Registration of one Trade Mark con-
sisting of the following:-


in Class 8 that is to say, phonograph
records in the form of discs, tapes,
wires, cylinders, and o t h e r media
used for recording and reproducing
sound.

The Applicants c 1 aim that they
have used the said Trade Mark in
rslpect of the said goods for seven
m 'nths before the date of their said
Application.

Any person may within three
months from the date of the first ap-
pearance of this Advertisement in the
" Antigua, M'lntserrat, nnd Virgin
Islands Gazette" give notice in du-
plicate at the Trade Marks Office,
Montserrat. of opposition of the said
Trade Mark.
D. F. JOHNSON.
Ag. Registrar of Trade Marks.


TRADE MARKS OFFICE,
MONTSERRAT 28th July, 1959.

GR U N D I G R A D I O-WERKE
Gesellschaft mit beschrankter
Haftung of Kurgartenatrasse 37,
Fnrth, Bavaria, Germany, have ap-
plied for Registration of one Trade
Mark consisting of the following:-


in Class 8 that is to say radio and
television apparatus and instruments;
apparatus for recording and repro-
ducing sound, and apparatus for
recording data, all using magnetic
material as the recording and repro-
ducing medium; eleccronic measuring
apparatus and instruments; and parts
of all these goods; dictating machines,
phonographs, copying machines,
electrical and mechanical typewriters,
electrical and mechanical calculating
machines. electrical and mechanical
tabulating machines, electrical and
mechanical accounting mac hin e s,
electrical and mechanical printing
and punching machine s, card perfo-
rating machines and machines com-
bined with each of them; television
cameras, loudspeakers, electric bat-
teries and p;rts and accessories of all
these good,;.

The Applicants claim that they
have used the said Trade Mark in
respect of some of the said goods for
approximately six years in Montserrat
before the date of their said
Application.

Any person may within three
months from the date o( the first ap-
pearance of this Advertisement in the
" Antigua, Monlserrat and Virgin
Islands Gazetce," give notice in (Iu-
plicate at the Trade Marks Office,
Montserrat of opposition of the said
Trade Mark.

D. F. JoIINsoN.
Ag. Registrar of Trade Mar1Js.


RAINFALL FIGURES

Agricultural Department,
Antigua.
Month 1955 1956 1957 1958 1959
January 2.16 5.15 3.16 0.92 2.91
February 0.68 1.23 2.29 0.66 1.16
March 0.83 1.40 0.40 122 0 73
April 1.75 3.83 2.54 2.01 3.61
May 2.81 2.58 1.19 7.79 9.02
June 1.47 5.72 2.86 1:3.15 0.4S
July 2.13 4.29 1.50 3..)5 2.57
To 1st Aiugst 0.00 0.00 OCO 0.07 0.00
11.83 2t-20 13.9! 2-7'7 20,48


TRADE MARKS OFFICE,
ANTIGUA, 21st July, 1959.

FEDERATED PHARMACUETI-
CAL CO. LTD. of 331 Harbour
Street, Kingston, Jamaica have ap-
plied for Registration of one Trade
Mark consisting of the following:-


in Class 2, that is to say: chemical
substances used for veterinary and
sanitary purposes.


in Class 3, that is to say: pharmaceu-
tical products, medicine ls and
antibiotics.

The Applicants claim that they
have not used the said Trade Mark in
reflect of the said goods before the
date of thrir said Application.

Any person may within three
months from the date of the first ap-
pearance of this Advertisement in the
"Antigua, ,,,ni, r,-at and Virgin
Islands Gazette," give notice in du-
plicate at the Trade Marks Office,
Antigua, of opposition to registration
of the said Trade Mark.

EVAN CREQUE,
Ag. Registrar of Trade Marks_


TRADE MARKS OFFICE,
ANTIGUA 21st July, 1959,

COLUMBIA PICTURES CORPO-
RATION of 711 Fifth Avenue, New
York, State of New York, U. S. A.
have applied for Registration of one
Trade Mark consisting of the
following:-


in Class 8, that is to say: phonograph
records in the form of dics, tapes,
wires, cylinders, and other media
used for recording and reproducing
sound.

The Applicants claim that they
have used the said Trade Mark in
re-pect of the said goods for seven
Inonths before the date of their said
Application.

Any person may within three
months from the date of the first ap-
pearance of this Advertisement in the
" Aniiqua, JMontserrat and Virgia
Islands Gazette," give notice in du-
plicate at the Trade Marks Office,,
Antigua, of opposition to registration
of the said Trade Mark.

EVAN CRQUvE,
Ag. Registrar of Trade Marks.


[Aupistt 6, 195








.ugu-t 6, 1959.] THE ANTIGUA, MONTSERRAT AND VIRGIN ISLANDS GAZETTE. 12%
TguA 6,95. D.0 osntbn isl


ANTIGUA.


Department of Agriculture,
Peasant Development Office.
Bids are invited for the purchase,
ex-warehouse, of stained cotton lint
(1959 crop) held by the Peasant De-
velopment Officer, An t i g u The
amount at present available is about
70 bales weighing about 20,000 lb.
Bids will be accepted for the whole
stock or for lots of five or ten bales.
Bids should state clear 1 y the price
per pound ex-warehouse and the
amount for which the bid is made.
The successful bidder or bidders must
be prepared to take delivery of the
lint immediately after notification of
the acceptance of bids or as soon as
called upon to do so by the P. D. O.


The P. D. 0. does not bind himself
to accept the highest or any bid.
Samples can be obtained on request.
Bids should be addressed to the
Peasant Development Officer, Anti-
gua, and should reach him on or
before 29th August 1959. Envelopes
should be marked Tender for
Stained Cotton on the outside.
MALCOLM PARK,
Director of Agriculture,
for Peasant Development Officer.
9th July, 1959.


Post of Librarian, Antigua.
Applications are invited for the
post of Librarian, Public Library,
Antigua, which post will become
vacant on 1st November, 1959.


2. Applicants should lihave- passed
a! ast \vo parts of the egistiraiii,
Examination of the Library Associd-
tion and have a thorough knowledge
of Public Library Administration.
3. The salary scale of the post is
$2260.80 x115.20-2491.20x $129.60-
2880 144-$3024 per annum. The
commencing salary within the salary
scale will depend on the qualifications
held by the applicant.
4. Applications sta t in g date of
birth, qualifications and experience
and accompanied by two recent testi-
monials (not applicable to Public
Officers) mnst be addressed to the
Administrator, Antigua, and should
reach him not later than the 15th
September 1959.
Administrator's Ofice,
St. John's,
June. 1959.


Hurricane Precautions, 1959.

1. At the beginning of the Hurricane Season the public are advised to take precautions
to safeguard their homes and other property in the event of a storm. During a hurricane the
central electricity supply will be turned off, and every household should therefore be provided with
a hurricane lantern or a flash light (or preferably with both) which should be checked regularly
1and kept in working order throughout the hurricane season.
2. Owners of barometers should take readings daily at 10 a.m., 4 p.m. and 10 p.m.
Any change lower than the usual diurnal one of 0-10 inch should be regarded with suspicion.
3. The masters or agents of vessels if in doubt should communicate with the arbour
Master for information.
4. When barring up a house, on indication of bad weather, begin with the side facing
the direction of the prevailing wind, which v:ris from North West to North East. Should the
centre of a storm pass over the island there will be a short period of calm during which the
Northern side of the building could be opened up and the Southern and Westerly sides closed.
Very often there is no calmn, and under such circumstances it is wise to have everything securely
.fastened.
5. The United States Weather Bureau at 'an Juan, Puerto Rico, issues regular weather
reports s for the Eastern ('aribbean which are Iroa;icast in Spanish and English daily throughout the
hurricanee season by several radio stations in Puerro i ico.

Storm Warning Signals.
AT DAY.
The following signals displayed at the Harbour Master's Office, Goat Hill, Ottos Hill,
(Michael's Mount) Police Headquarters and other Police stations in the Island
denote the approach of disturbed weather:-
A. A RED FLAG with black square in centre means Tropical disturbance reported;
likely to affect island of Antigua-CAUTION ADVISED.
B. TWO RED FLAGS, with black squares in centre-HURRICANE SIGNAL-
DANGER EXPECTED.
AT NIGHT.
A. TWO DETONATING IROCKETS will be Fired from the Harbour Master's O'iic
to warn shipping
B. A REED LIGHT will be displayed at Police Stations.
DAY & NIGHT.
The Police will go through St. John's and Villages sounding their whistles.
Telephone Exchanges will inform sub-c(ribers. After a hurricane warning has heryt
receive the news will be broiadin!it by ItLlio Antigua (c..25 megac\eles; 92 16
metres) at regular intervals:-9 a.m., 5 p m. and more olten if necessary.
Administrator's Oice,
St. John's, Antigua.
21st July, 1959.
Ilef. No. A. 52/6.
Printed at the Government Printing Office. Antigun, Leeward Islands,
by EARL PIGOTT, Governatiant Printer.-By Authority.
[Priee $1.271







ANTIG UA.



STATUTORY RULES AND OR SEP19!

1959 No. 28.



Proclamation dated 28th July, 1959, bringing into opera-
tion the Beach Control Ordinance, 1958 (No. 6 of 1958).



BY THE GOVERNOR.

A PROCLAMATION

I. G. TURBOTT,
Administrator.

WHEREAS by section 11 of the B-ach Control Ordinance, 1958,
(No.6/1958) it is provided that the said Ordinance shall come into opera-
tion on a day to be appointed by the Governor by proclamation published
in the Gazette.

Now, THEREFORE I, AN GRAHAM TURBOTT, Administrator of the
Colony of Antigua, do by this my proclamation declare that the said
Ordinance shall come into operation on the twenty-eighth day of July,
1959.

AND all Her Majesty's loving subjects in the Colony of Antigua and
all others whom it may concern are hereby required to take due notice
hereof and to give their ready obedience accordingly.

GIVEN at tho Administrator's Office, Antigua, this twenty-eighth day
of July, 1959, in the eighth year of Her Majesty's reign.

GOD SAVE THE QUEEN!







Printed at the Government Printinz Offloe, Antigna, Leeward Islands
by EARL PIGOTT, Governmant Printer--y Authtorit).
1959.


500-8.59.
3>J 7 .9 7


/IA


[Price 5 cents]




i7



MONTSERRIT rp1
0i 23 SEP y c/

STATUTORY RULES A- -R DERS.
1958, No. 35
THE WORKMEN'S COMPENSATION REGULATIONS, 1958, DATED
JULY 3, MADE BY THE GOVERNOR IN COUNCIL UNDER SECTION
50 OF THE WORKMEN'S COMPENSATION ORDINANCE, 1957
(No. 5 of 1957).


1. SHORT TITLE. These Regulations may be cited as
the Workmen's Compensation Regulations, 1958.

2. INTERPRETATION. In these Regulations unless the
context otherwise requires -
"clerk" means the clerk of the court;
"the Court" means a magistrate's court having juris-
diction in any matter under the Ordinance;
"the Ordinance" means the Workmen's Compensation
Ordinance, 1957;
"Schedule" means Schedule to these Regulations;
"section" means a section of the Ordinance.

PART I.
PROCEDURE ON APPLICATION FOR
COMPENSATION.
3. APPLICATIONS UNDER SECTION 37 (1). Any applica-
tion of the nature referred to in section 37 (1) shall be
filed with the clerk and shall unless the court otherwise
directs be made in Form 1 or Form 2 in Schedule A, as the
case may require, and shall be signed by the applicant.
4. APPLICATION BY EMPLOYER UNDER SECTION 37 (1). (1)
Where the employer on whom a claim for compensation
has been made desires to make an application under sec-
tion 37(1) he shall file an application in accordance with
regulation 3 to which the workman or his legal personal
representative, if any, and the persons claiming or who
may be entitled to be dependants of a deceased workman,
or the other persons (as the case may be) on whose behalf
the claim was made, shall be respondents.

(2) The application shall have appended or annexed
thereto the following particulars:-

(a) a concise statement of the circumstances
under which the application is made;



6 MLqe







(b) a statement whether the applicant admits his
liability to pay compensation, or denies such lia-
bility, wholly or partially, with (in the latter case) a
statement of the grounds on and extent to which he
denies liability;

(c) a. statement of the matters which the appli-
.cant desires to have settled by the application; and

(d) the full names and addresses of the respon-
dents and of the applicant, and of his solicitor, if the
proceedings are commenced through a solicitor.
5. MASTERS, .SEAMEN, APPRENTICES. In the application
of the Ordinance and these Regulations in the case of
masters, seamen, and apprentices to the sea service who
are workmen within the meaning of the Ordinance, and
who are members of the crew of any such ship a.sin section
33 mentioned,, and to any person not being a master, sea-
man, or apprentice to the sea service employed on board
any such ship as in section 33 mentioned, if he is so em-
ployed for the purposes of the ship or of any passengers
or cargo or mails carried by the ship who are workmen
within the meaning of the Ordinance, the following para-
graphs shall have effect:-

(a) in the case of the death of a master, seaman,
or apprentice, the claim for compensation shall state
the date at which news of the death was received by
the claimant;
(b) the claim for compensation on behalf of
dependants of a master, seaman, or apprentice lost
with his ship, and the particulars appended or annexed
to the application for compensation, shall state the
date at which the ship was lost or is deemed to have
been lost;

(c) an application for compensation under section
33 shall be according to Form 3 or Form 4 in Schedule
A as shall be applicable to the case, with such modi-
fications as the nature of the case shall require;

(d) in any document, notice, or proceeding it shall
be sufficient to describe the owners of the ship as "The
owners of the ship ;
and the provisions of the Rules of the Supreme Court
as to disclosure of the names of partners shall with
the necessary modifications apply to the disclosure of
the names of such owners;

(e) subject to the provisions of subsection (1)(a)
of section 33 as to service of notice of accident and the
claim for compensation, any document, notice or







proceeding to be served on the owners of a ship shall
be deemed to be sufficiently served if served on the
managing owner or manager for the time being of the
ship, or (except where the master is claiming com-
pensation) on the master of the ship; and subsection
(1) of section 696- of the Merchant Shipping Act, 1894,
shall apply to service on the master of the ship, and
where the master is claiming compensation, and there
is no managing owner of the ship, service may be
effected in accordance with paragraph (c) of the said
subsection.

6. NOTICE TO RESPONDENT. The clerk shall cause to be
served on the respondent a copy of the application and
shall call upon the respondent within seven days from the
service of the copy of such notice to file a written answer
containing a concise statement of the extent and grounds
of opposition, if any, to the claim, *

7. ANSWER BY RESPONDENT. The respondent shall,
within seven days from the service of the copy of such
notice or such further time as the court may allow, file
with the clerk a written answer containing a concise state-
ment of the extent and grounds of opposition, if any to
the claim raised in the application, and any such answer
shall form part of the record.

8. PROCEDURE WHEN INDEMNITY CLAIMED UNDER SECTION
25 (2). Where the respondent claims that if compensation
is recovered against him he will be entitled under subsec-
tion (2) of section 25 to be indemnified by a person not be-
ing a party to the case (hereinafter referred to as "the
third party") he shall, within seven days after being served
with the copy of the application, file a notice of such claim
with the clerk, and the clerk shall thereupon cause a copy
of the notice of such claim in Form 5 in Schedule A to be
served upon the third party, and the third party shall file
a. written answer dealing with the matters raised in appli-
cation or with the claim for indemnity or both within
seven days from the service of the copy of the notice
thereof or such further time as the court may allow.

9. PROCEDURE WHERE CLAIM ADMITTED. If the respond-
ent or the third party admits the claim, he may at any
time before the first hearing -

(a) where the application is made by an injured
workman -

(i) file with the clerk a notice that he submits
to an order for the payment of a weekly sum, to.
be specified in such notice; or








(ii) file with the clerk a notice that he submits
to an order for the payment of a lump sum, to be
specified in the notice, and pay such sum into
court;

(b) where the application is made on behalf of the
dependants of a deceased workman, or for the settle-
ment of the sum payable in respect of medical attend-
ance and the burial of a deceased workman who
leaves no dependants, file with the clerk a notice that
he admits liability, and pay into court such sum of
money as he considers sufficient to cover his liability
in the circumstances of the case.

10. FAILURE OF RESPONDENT OR THIRD PARTY TO FILE
STATEMENT. If the respondent or the third party fails to
file a written answer dealing with the claim within the
prescribed time br within the time fixed by the court on
application to enlarge the time, he shall be taken to admit
the claim.

11. DATE AND PLACE OF HEARING. (1) Where it is
necessary to proceed to a hearing the court shall fix a date
and place for disposing of the application under regulations
3 or 5, or of the claim for indemnity, if any, under regula-
tion 8 of these Regulations; and shall cause a notice of
hearing in Form 6 in Schedule A to be served on the differ-
ent parties calling upon them to produce any evidence
which they may wish to tender.

(2) The date of hearing of an application under
regulations 3 or 5 of these Regulations shall be so fixed as
to permit not less than fourteen clear days to elapse
between the service of the application on the respondent
and the hearing of the said application.

12. NON APPEARANCE OF APPLICANT. If, on the day of
hearing of any application or at any adjournment thereof,
the applicant does not appear, the application shall be dis-
w'missed, unless the court having received a reasonable
excuse for the non-appearance of the applicant or for other
sufficient reason, thinks fit to adjourn the hearing to some
future day upon such terms as to costs as the court may
think just.

13. ABSENCE OF RESPONDENT OR THIRD PARTY. If on
the day of hearing of any application or at any adjourn-
ment thereof, the respondent or third party does not
appear, the court may proceed to hear the case in his
absence, unless the court, having received a reasonable
excuse for his absence, or for other sufficient reason, thinks
fit to adjourn the hearing to some future day upon such
terms as to costs as the court may think fit.







14. RECORD OF PROCEEDINGS. There shall be recorded
in every proceeding a note of the steps taken on the appli-
cation.

15. ORDERS. (1) A magistrate, in making orders, shall
record concisely his findings and his reasons for such
findings.

(2) The magistrate, at the time of signing and dating
his order, shall pronounce his decision, and thereafter no
addition or alteration shall be made to the order other than
the correction of a clerical or arithmetical mistake arising
from any accidental slip or omission.

(3) An order shall be in such one of Forms 7, 8 or 9
in Schedule A as shall be appropriate to the circumstances
of the case, with any necessary variation.
16. RIGHT OF ENTRY FOR LOCAL INSPECTION. A magis-
trate before whom any proceeding relating to an injury by
accident is pending may at any time enter the place where
the workman was injured, or where the workman
ordinarily performed his work, for the purpose of making
a local inspection or of examining any persons likely to be
able to give information relevant to the proceedings:

Provided that the magistrate shall not enter a.ny prem-
ises of any industrial establishment except during the
ordinary working hours of that establishment, save with
the permission of the employer or of some person directly
responsible to him for the management of the establish-
ment.

17. PROCEDURE IN CONNECTION WITH LOCAL INSPECTION.
(1) If the magistrate proposes to conduct a local inspection
with a view to examining on the spot the circumstances
in which an accident took place, he shall give the parties
or their representatives notice of his intention to conduct
such inspection, unless in his opinion the urgency of the
case renders the giving of such notice impracticable.

(2) Such notice may be given orally or in writing,
and, in the case of an employer, may be given to any per-
son upon whom notice of a claim can be served under sub-
section (2) of section 16 or to the representative of any such
person.

(3) Any party, or the representative of any party,
may accompany the magistrate at a local inspection.

18. PROCEDURE IN CONNECTED CASES. Where two or
more cases pending before a magistrate arise out of the
same accident, and any issue involved is common to two or







more such cases, such cases may, so far as the evidence
bearing on such issue is concerned, be taken together.
19. SUMMONING OF WITNESSES. If an application is
presented by any party to the proceedings for the citation
of witnesses, the clerk shall, on payment of the prescribed
expenses and fees, issue summonses for the appearance of
such witnesses, unless the magistrate considers that their
appearance is not necessary for the just decision of the
case.
20. EXEMPTION FROM PAYMENT OF FEES. It the magis-
trate is satisfied that the applicant is unable, by reason of
poverty, to pay the prescribed fees, he may remit any or
all of such fees. If the case is decided in favour of the
applicant, the prescribed fees which, had they not been
remitted, would have been due to be paid, may be added to
the costs of the case and recovered in such manner as the
magistrate in his order regarding costs may direct.

21.- FILING AND SERVICE OF DOCUMENTS, (1) Where
any document is to be filed with the clerk under these
Regulations, that document may be so filed by delivering it
at the office of the clerk or by sending it by registered post
to the clerk at his office,

(2) Where any document is to be filed, there shall be
filed with the original document as many copies of the
document as there are persons on whom copies of the
document are to be served, and in addition a copy for the
use of the magistrate.

(3) Where any document is under these Regulations
to be served upon any person, such document may be
served -
(a) upon the Crown, by service upon the Head of
the Department in which the applicant was employed
at the time of the accident, or by leaving it at the office
of such Head of Department;
(b) upon an individual, by service upon him per-
sonally or by leaving it at his last known place of abode
or business;
(c) upon a Town or Village Council or Board by
service on the Town Clerk or the Secretary of such
Council or Board, as the case may be, or by leaving it
at his office;

(d) upon a corporate body, by service on the secre-
tary or by leaving it at the registered office of such
corporate body;
(e) upon a Club, by service on the secretary or
any member of the Managing Committee;







(f) upon the master of a ship or a person belonging
to a ship, by service on such master or person by leav-
ing the document for such master or person on board
the ship with the person being or appearing to be in
command or charge of the ship, or where no such per-
son can be found, by affixing a copy of the document
to the mast of the ship.

22. APPORTIONMENT OF COMPENSATION BETWEEN DEPEND-
ANTS. The provisions of this Part of these Regulations
shall, as far as may be, apply in the case of any proceedings
relating to the apportionment of compensation among
dependants of a deceased workman.

23. APPLICATION FOR DETENTION OF SHIPS. (1) An appli-
cation for the detention of a. ship under section 34 shall be
made in accordance with the provisions of the succeeding
paragraphs of this -regulation.

(2) The application may, subject to the provisions of
paragraph 8 of this regulation, be made ex parte either in
or out of the Supreme Court, according to Form 10 in
Schedule A, and shall be supported by affidavit or other
evidence showing to the satisfaction of the judge, the
grounds on which the application is made.

(3) The judge may, before granting the application,
require the applicant to give or procure an undertaking in
Form 11 in Schedule A or such other form as the judge
may require, to the satisfaction of the judge, to abide by
any order as to damages and costs which may be thereafter
made, in case any person affected by the order for deten-
tion shall sustain any damages by reason of the order
which the applicant ought to pay.

(4) An order for detention shall specify the amounts
for which security shall be given and shall be according to
Form 12 in Schedule A, and shall be issued in triplicate;
one copy shall be delivered to the applicant, and the other
two copies to the officer named by the judge; and one of
such last-mentioned copies shall be delivered by the officer
to the person who is at the time of the execution of the
order apparently in charge of the ship, or shall be nailed
or affixed on the main mast or on the single mast of the
ship; and the other copy shall be retained by the officer.

(5) The judge may at any time on good cause shown
rescind any order for detention made by him.

(G) The provisions of the Rules of the Supreme Court
as to security, shall with the necessary modifications apply
to the giving security; and the approval by the judge of







aniy security shall be signified in writing signed by hint.
Where security is given by bond, such bond shall be accord-
ing to Form 13 in Schedule A.
(7) If the judge rescinds any order for detention, or is
satisfied that satisfaction has been made, or when security
ha.s been given and approved, or in any other case if the
applicant so requires, the judge shall deliver tc the party
applying for the same an order according to Form 14 in
Schedule A, directed to the officer named in the order for
detention authorising and directing him, upon payment of
all costs, charges, and expenses attending the custody of
the ship, to release it forthwith.

(8) With respect to notices of applications for orders
for detention, and to undertakings to give security, the
following provisions shall have effect:-
(a) notwithstanding anything in this regulation
contained, a person intending to apply for an order for
detention shall, if the name and address of an agent
in the Colony for the owner of the ship, or of a solici-
tor in the Colony authorised to act for the owners,
agent, master, or consignee of the ship, are known to
him, give to such agent or solicitor by post or other-
wise, such notice of the time and place at which the
application for an order for detention is intended to
be made as may be practicable in the circumstances of
the case;
(b) if a solicitor in the Colony represents that he
is authorised to act for the owners, agent, master, or
consignee of the ship, and signs an undertaking
according to Form 15 in Schedule A to put in or give
security for an amount agreed on between the parties
or fixed by the judge, then, on such undertaking being
filed in the Supreme Court, the judge may in his dis-
cretion refuse to make an order for detention, or if an
order for detention has been made, but not executed,
the judge may rescind it, or if an order for detention
has been made an executed, the judge may deliver to
the party applying for the same an order of release in
accordance with paragraph (7) of this regulation;
(c) a solicitor who fails to put in or give security
in pursuance of his undertaking to do so shall be
liable to attachment.

(9) Where proceedings for the recovery oi compensa-
tion are taken against the persons giving security, the
application for compensation and particulars shall state
concisely the circumstances under which the persons giv-
ing security are made respondents. The application shall
be in Form 16 in Schedule A.







(10) The costs incurred by any party in relation to an
application for an order of detention and any proceedings
consequent thereon may in any subsequent proceedings for
compensation be allowed as costs in the application for
compensation.

(11) This regulation shall apply to claims against
charterers under subsection (5) of section 34, "charterers"
being substituted for "owners" in these cases.

PART II.

PROCEDURE WITH REGARD TO AGREEMENTS.

24. FORM OF MEMORANDUM OF AGREEMENTS. (1) A
memorandum of agreement sent to the court under sub-
section (1) of section 21 shall unless the court otherwise
directs, be in duplicate, and shall be in as close conformity
as the circumstances of the case permit with one of the
Forms 17 and 18 in Schedule A as the case may require.

(2) Every such memorandum shall contain the like
particulars as would have been required if the memoran-
dum had been an application for compensation under
these Regulations.

25. APPLICATION TO HAVE AGREEMENT MADE A JUDGMENT
OF THE COURT. Where an application is made to have an
agreement made a judgment of the court, a memoran-
dum thereof shall be sent by an interested party to the
clerk who shall on being satisfied as to its genuineness
record such memorandum in a special register to be kept
for that purpose:

Provided however that no such memorandum shall be
recorded before fourteen days after the despatch by the
clerk by registered post, of a notice in Form 19 in Schedule
A to the parties interested.

26. REGISTRATION OF MEMORANDUM ACCEPTED FOR
RECORD. In recording a memorandum of agreement, the
magistrate shall cause the same to be entered in the special
register, and shall cause an endorsement to be made under
his signature on a copy of the memorandum to be filed in
the following terms, namely:-

"This memorandum of agreement bearing Serial
No. of 19 in the register of
agreement has been recorded this day of

(Signature)

Magistrate."







PART III.


REVIEW ON REDEMPTION OF WEEKLY OR
HALF-MONTHLY PAYMENTS.

27. WHEN APPLICATION MAY BE MADE WITHOUT MEDICAL
CERTIFICATE. Any application for review of a weekly
or half-monthly payment under section 12 shall be
in Form 20 in Schedule A and may be made without a
medical certificate -
(a) by the employer, on the ground that since the
right to compensation was determined the workman's
wages have increased;
(b) by the workman, on the ground that since the
right to compensation. was determined his wages have
diminished;

(c) by the workman, on the ground that the em-
ployer, having commenced to pay compensation, has
ceased to pay the same notwithstanding the fact that
there has been no change in the workman's condition
such as to warrant such cessation;
(d) by the workman, on the ground that he has
ceased, since the right to compensation was deter-
mined, to be a minor;

(e) either by the employer or by the workman, on
the ground that the determination of the rate of com-
pensation for the time being in force was obtained by
fraud or undue influence or other improper means.
28. PROCEDURE ON APPLICATION FOR REVIEW. If on
S examining an application for review by an employer in
which the reduction or discontinuance of weekly or half-
monthly payments is sought, it appears to the magistrate
that there is reasonable ground for believing that the
S employer has a right to such reduction or discontinuance
he may at any time issue an order withholding the weekly
or half-monthly payments in whole or in part pending his
decision on the application.
S29. PROCEDURE ON APPLICATION FOR REDEMPTION. (1)
Any application for redemption of a right to receive weekly
oi half-monthly payments by the payment of a lump sum
shall be in Form 20 in Schedule A.

(2) Where application is made to the court under
subsection (2) of section 12 for the redemption of a right
to receive weekly or half-monthly payments by the pay-
ment of a lump sum, the court shall form an estimate of







the probable duration of the disablement, and shall award
a sum equivalent to the total of the weekly or half-monthly
payments which would be payable for the period during
which he estimates that the disablement will continue,
less one half per cent of that total for each month com-
prised in that period.

(3) When, in any case to which paragraph (2) of this
regulation applies, the magistrate is unable to form an
appropriate estimate of the probable duration of the dis-
ablement he may from time to time postpone a decision on
the application for a period not exceeding two months at
any one tnie.
30. APPLICATION FOR ORDER WHEN WORKMAN UNDER
DISABILITY. An application under subsection (6) of section
14 for an order that a weekly or half-monthly payment
payable to a workman under any legal disability shall
during the disability be paid to any dependant or other per-
son may be made either by the person liable to make such
payment or by or on behalf of the workman entitled to
such payment. The application shall be made in Form 21
Schedule A and shall be served on every interested party;
31. APPLICATION FOR VARIATION OF ORDER. An appli-
cation for the variation of an order of the court under
subsection (7) of section 14 may be made by or on behalf of
any person interested. The application shall be made in
Form 22 in Schedule A stating the circumstances under
which the application Is made and the relief or order which
the applicant claims, and shall be served on every other
interested party.

PART IV.

DEPOSIT OF COMPENSATION.
32. DEPOSIT OF COMPENSATION GENERALLY. Compensa-
tion shall be deposited with the clerk -

(a) under an order of the court directing a specific
sum to be paid in as compensation; or
(b) under an' agreement between an employer or
other person liable to pay compensation and a work-
man or the dependants of a workman according to the
tenor thereof; or

(c) pursuant to a claim for compensation or to an
application for compensation, against an employer or
other person liable to pay the same who admits lia-.
bility, or denies liability but is willing to pay an
amount in settlement of the claim.







33. DEPOSIT UNDER SECTION 14 (1). (1) An employer
depositing compensation under subsection (1) of section 14
shall furnish therewith a statement in Form 23 in
Schedule A.

(2) If, in the statement above referred to, the em-
ployer indicates that he desires to be made a party to the
distribution proceedings, the magistrate shall, before
allotting the. sum deposited as compensation, afford to the
employer an opportunity of establishing that the person to
whom he proposes to allot such sum is not a. dependant of
the deceased workman, or as the case may be, that no one
of such persons is a dependant.

(3) Any dependant, whether notice under subsection
(5) of section 14 has been published or not, may apply to
the magistrate for the payment out or distribution of any
sum so deposited.

(4) The statement of disbursements to be furnished
on application by the employer under subsection (5) of
section 14 shall be in Form 24 in Schedule A.

34. DEPOSITS. An employer depositing compensation
in accordance with subsection (2) or subsection (3) of sec-
tion 14 shall furnish therewith a statement' in Form 25 in
Schedule A.
PART V.

MEDICAL REFEREES.

35. REFERENCE BY COURT TO MEDICAL REFEREE FOR
REPORT UNDER SECTION 36 (2) (i). Before making any refer-
ence to a medical referee under paragraph (i) of subsec-
tion (2) of section 36, the court shall be satisfied after
hearing all the medical evidence tendered by either side,
that such evidence is either conflicting or insufficient on
some matter which seems material to a question arising in
the proceedings, and that it is desirable to obtain a report
from the medical referee on such matter.

(2) Every such reference shall be made in writing
and shall state the matter on which the report of the
medical referee is required, and the question arising in the
proceedings to which such matter seems .to be material.
Such reference shall be in accordance with Form 26 in
Schedule A or as near thereto as may be.

(3) The reference shall be accompanied by a general
statement of the medical evidence given on behalf of the
parties.







(4) On making a reference to the medical referee
the court shall maKe an order in Form 27 in Schedule A
directing the workman to submit himself for examination
by the medical referee and the medical referee shall on
receipt of the reference appoint a time and place for the
examination of the workman and send him notice
accordingly.

(5) Before making an order as required by paragraph
(4) of this regulation, the court shall inquire whether the
workman is in a fit condition to travel for the purpose of
the examination, and if the court is satisfied that he is in
a fit condition it shall by the same order direct him to
attend at such time and place as the medical referee may
fix and it shall be the duty of the workman' to obey any
such order.

(6) If the court is satisfied that the workman is not
in a fit condition to travel this fact shall be stated in the
reference,

(7) The medical referee shall give his report in writ-
ing and shall forward it to the magistrate from whom he
received his reference,

36, REFERENCE TO A MEDICAL REFEREE UNDER SECTION
47 (2). (1) Where a magistrate refers a, matter to a medi-
cal referee under subsection (2) of section 47, he shall
issue a reference to the medical referee in Form 28 in
Schedule A and the medical referee shall forthwith on
receipt of such reference fix a time and place for the
examination of the workman and shall send notice accord-
ingly to the workman and the employer.

(2) Before giving the certificate required by the refer-
ence the medical referee shall personally examine the
workman and shall consider any statement that may be
made or submitted by either party.

(3) The certificate given by the medical referee shall
be according to Form 29 in Schedule A and shall be for-
warded by him to the magistrate from whom he received
his reference.

37. REFERENCES To MEDICAL REFEREE TO BE SIGNED.
Every reference to a medical referee under regulation 35
or regulation 36 of these Regulations shall be signed by
the magistrate by whom it is issued.
38. NOTICES TO BE ISSUED BY MEDICAL REFEREE. The
notice to be issued by a medical referee to -
(a) a workman as required by paragraph (4) of
regulation 35;







S(b) a workman as required by paragraph (1) of
Regulation 36;

(c) an employer as required by paragraph (1) of
regulation 36,
shall be in Forms 30, 31 and 32 respectively in. Schedule A.

39. REMUNERATION AND EXPENSES OF MEDICAL REFEREE.
The remuneration of and other expenses incurred by a
medical referee which are required to be paid under section
46(3) shall be as set out in Part I Schedule B.

PART VI.

SUPPLEMENTARY PROVISIONS.

40. STATEMENT OF WAGES TO BE FURNISHED BY
EMPLOYER. Where any proceeding is taken or is about to be
taken for the determination of any question arising out of
S an accident in which compensation is or might be claimed,
the employer shall, if required by the workman, furnish
the workman, within seven days from the date of requisi-
tion, with a statement showing:-
(a) the total wages which have fallen due for
payment to the workman by the employer in the last
twelve months, where the workman has been employed
during a continuous period of not less than twelve
months immediately preceding the accident; or

(b) the total wages earned in respect of the last
continuous period of service, where that service is of
less than twelve months duration immediately pre-
ceding the accident.

41. REGISTRATION OF EMPLOYERS. (1) The form of
application for registration required by section 26(1) for
employers to whom section 24 applies shall be according to
Form I in Part II of Schedule B.
: (2) The Labour Commissioner shall, upon receipt of
an application made under paragraph (1) of this regula-
tion and on being satisfied that the particulars contained
in the application are correct, issue to the employer a cer-
tificate of registration as in Form 2 in Part II of the said
Schedule B.

42. SOLICITORS' COSTS AND ALLOWANCES TO PARTIES
AND WITNESSES. (1) Any costs of or incidental to any pro-
S ceedings for the determination of any question arsing out
of an accident to a workman shall be forwarded in accord-
ance with the scale of costs for solicitors and allowances
for parties and witnesses in Part III of Schedule B,








(2) The fees allowable under the said scale of
costs shall include and cover all costs whatsoever incidental
to the proceedings, except fees of court and'necessary dis-
bursements.

43. MEDICAL PRACTITIONERS' FEES. The fees required
to be paid under section 6(2) (a) to a medical practitioner
who renders emergency. treatment to an injured workman
shall be as specified in. Part IV in Schedule B.

44. COURT FEES. The fees of Court specified in Part V
in Schedule B shall be paid in respect of proceedings brought
under the Ordinance.

45. MODIFICATIONS OF FORMS. Where the forms in
Schedule A are not applicable, forms of the like character,.
with such, variations as the circumstances may require,
may be used in proceedings under the Ordinance.

46. COMMENCEMENT. These Regulations shall be'
deemed to have come into operation on the 1st day of
July, 1957.

Made by the Governor in Council this 3rd day of
July, 1958.

GEORGE R. E. CABEY,
Clerk of the Council.


Reg. 3
SCHEDULE A.
FORM 1.

Application for Compensation by Workman or by Employer.

MONTSERRAT.

IN THE MAGISTRATE'S COURT, DISTRICT

In the matter of the Workmen's Compensation
Ordinance, 1957,
and
In the matter of an Application by a Workman
for Compensation.

Between
A.B. residing at Applicant.
and


residing at


Respondent,


C.D.








The applicant, a workman employed by
(a contractor with) the Respondent
(or, the applicant is bne employer of the abovenamed
Respondent, a workman who) sustained personal injury by
accident arising out of and in the course of his employ-
ment on the day of at
and applies herein for the determination of
the questions hereinafter stated under the provisions of
the Workmen's Compensation Ordinance, 1957.

Particulars.

1. Place of business and nature
of business of Respondent.
2. Nature of employment of
workman at time of accident, and
whether employed under opposite
party or under a contractor with
him (if employed under a con-
tractor who is not a respondent,
name and place of business of con-
tractor to be stated.)

3. Date and place of accident,
nature of work on which workman
was then engaged, and nature of
accident, and cause of injury.
4. Nature of injury.

5. Particulars of incapacity for
work, whether total or partial,
and estimated duration of in-
capacity.

6. Monthly wages during the 12
months previous to the injury, if
applicant has been so long em-
ployed under the employer by
whom he was immediately em-
ployed, or if not, during any less
period during which he has been
so employed.
7. Monthly amount which the
applicant is earning or is able to
earn in some suitable employment
or business after the accident.
8. Payment, allowance or benefit
received from employer during
the period of incapacity.
9. Amount claimed as compen-
sation.







10. Date of service of statutory
notice of accident on employer,
and whether given before work-
man voluntarily left the employ-
ment in which he was injured.
(A copy of the notice to be
annexed.)

11. If notice not served, reason
for omission to serve same.
12. (a) The names and addresses
of the applicant and his attorney
or agent are:

of the applicant
of his attorney or agent

(b) The name and address
of the respondent to be served
with this application are:

13. Date of claim for compen-
sation.

Questions for the determination of the Court:-

(a) whether the applicant is a workman within
the meaning of the Ordinance;

(b) whether the accident arose out of and in the

(c) whether the amount of compensation claim-
ed is due, or any part of that amount;

(d) whether the respondent is liable to pay such
compensation as is due;

(e) ............................ (as required)

Dated the day of 19
Applicant
or (Attorney or agent for Applicant
residing at ).

(If application is made by an employer append or annex
here statement required by section 37(2) of the Ordinance.)

NOTICE.

To of
You are hereby required if you intend to oppose the
above application to lodge with me the undersigned clerk
within seven days after the service of this notice upon







you (or within such extended period as the magistrate may
allow) a written answer to the application containing a
concise statement of the extent and grounds of your
opposition thereto.

The above application will be heard at the Magistrate's
Court, District at on
the day of at o'clock
in the noon and you are hereby notified that if
you fail to lodge such answer within the time herein
prescribed or to appear at the time and place herein stated
for the hearing of the application such order may be made
against you as may be just and expedient.

Clerk
Magistrate's Court, District



Form 2. Reg. 3.

Application for Compensation by Dependants or by
Employer.
MONTSERRAT.

IN THE MAGISTRATE'S COURT, DISTRICT

In the Matter of the Workmen's Compensation
Ordinance, 1957
And
In the Matter of an Application for Compensation by
Dependents.

Between:

A.B. residing at Applicant.
and
C.D. residing at Respondent.

The applicant is the legal personal representative (or
the dependent) of a workman employed by (a contractor
with) the respondent (or, The applicant was the employer
of a workman) who sustained personal injury by accident
arising out of and in the course of his employment on the
day of at
resulting in his death, and applies herein for the deter-
mination of the questions hereinafter stated under the pro-
visions of the Workmen's Compensation Ordinance, 1957.

Particulars.

1. Name and late address of de-
ceased workman.








2. Place of business and nature of
business of employer from whom
compensation is claimed.

3. Nature of employment of de-
ceased at the time of accident, and
whether employed under the alleged
employer or under a contractor with
him. (If employed under a contractor
who is not a respondent, name and
place of business of contractor to be
stated).

4. Date and place of accident,
nature of work on which deceased was
then engaged, nature of accident and
cause of injury, and age of deceased at
time of death.

5. Nature of injury to deceased and
date of death.

6. Monthly wages during the 12
months previous to the injury, if the
applicant has been so long employed
under the employer by whom he was
immediately employed, or if not,
during any less period during which
he has been so employed.

7. Amount of weekly or half-
monthly payments (if any) made to
the deceased under the Ordinance and
of any lump sum paid in redemption
thereof.

8. Character in which applicant
applies for compensation, i.e., whether
as legal personal representative of
deceased or as a dependent, and if as
a dependant particulars showing how
he is so.

9. Particulars as to dependants of
deceased by whom or on whose behalf
the application is made, giving their
names and addresses, and descrip-
tions and occupations (if any) and their
relationship to the deceased, and if
infants, their respective ages, and
stating whether they were wholly or
partially dependent on the earnings
of the deceased at the time of his
death.








I0. Particulars as to any person
claiming, or who may be entitled to
claim to be dependants, but as to
whose claim a question arises, and
who are therefore made respondents,
with their names, addresses, and
descriptions and occupations (if any).

S11. Particulars of amount claimed
as compensation, and of the manner
in which the applicant claims to have
such amount apportioned and applied.

12. Date of service of statutory
notice of accident on employer and
whether given before deceased volun-
tarily left the employment in which
he was injured. (A copy of the
notice to be annexed).

13. If notice not served, reason for
omission to serve same.

14. (a) The names and addresses
of the applicant and his attorney or
agent are:
of the applicant
of his attorney or agent

(b) The name and address of the
respondent to be served with this
application are:


Questions for the determination of the Court:-

(a) whether the applicant is a workman within
the meaning of the Ordinance;

(b) whether the accident arose out of and in the
course of the workman's employment;

(c) whether the amount of compensation claim.
ed is due, or any part of that amount;

(d) whether the respondent is liable to pay such
compensation as is due;

(e) whether the applicants) is a dependant(s)
are
of the deceased;

(f) how the compensation when deposited,
should be distributed;







(g) ............................................ (as required)
Dated the day of 19
Applicant,
or (Attorney or Agent for Applicant
residing a.t ).
(If application is made by an employer append or annex
here statement required by section 37(2) of the Ordinance.)

NOTICE.
To of
You are hereby required if you intend to oppose the
above application to lodge with me the undersigned clerk
within seven days after the service of this notice upon you
(or within such extended period as the magistrate may
allow) a written answer to the application containing a
concise statement of the extent and grounds of your
opposition thereto.

The above application, will be heard at the Magistrate's
Court, District at on
the day of at o'clock in the
noon and you are hereby notified that if you fail
to lodge such answer within the time herein prescribed, or
to appear at the time and place herein stated for the hear-
ing of the application such order may be made against you
as may be just and expedient.

Clerk,
Magistrate's Court, District



Form 3. Reg. 5(a).
Application for Compensation by an Injured Master,
Seaman, or Apprentice.

MONTSERRAT.

IN THE MAGISTRATE'S COURT, DISTRICT

In the Matter of the Workmen's Compensation Ordinance,
1957

And
In the Matter of an Application by an Injured Master,
Seaman, or Apprentice for compensation.

Between:
A.B. Applicant.
and







The owners of the ship "


1. On the day of personal injury
by accident arising out of and in the course of his employ-
ment was caused to A.B. the master
of the ship (or a seaman, or
an apprentice to the sea service) and a member of the crew
of the ship "

2. A question has (or questions have) arisen
(here state the questions, specifying only those which have
arisen, e.g.) -
(a) as to whether the said A.B.
is a workman within the meaning of the abovemen-
tioned Ordinance; or
(b) as to the liability of the owners of the said
ship to pay compensation under the abovementioned
Ordinance in respect of the said injury; or
(c) as to the amount (or duration) of the com-
pensation payable by the owners of the said ship to
the said A.B under the above-
mentioned Ordinance (or as the case
may be).

3. An inquiry under the abovementioned Ordinance is
hereby requested between the said A.B.
and the owners of the said ship for the settlement of the
said question (or questions),

4. Particulars are hereby appended (or annexed).

Particulars.

1. Name and address of
applicant.
2. Name of ship of which
applicant was master (or of
the crew of which applicant
was a member) at the time
of accident, and port of
registry.

3. Such other particulars as are contained in para-
graphs 2 to 11 in Form 1 of this Schedule as may be
applicable.

The names and addresses of the applicant and his
solicitor are:

Of the Applicant,
Of the Solicitor,


" Respondents.







The name and address of the person to be served
with this application as representing the owners of the
ship are:

(State name and address of managing owner or
manager, or of master of ship. See reg. 5(e) ).

Dated this day of 19
Applicant.
or (Applicant's Solicitor).

NOTICE.

To of
You are hereby required if you intend to oppose the
above application to lodge with me the undersigned clerk
within seven days after the service of this notice upon you
(or within such extended period as the magistrate may
allow) a written answer to the application containing a
concise statement of the extent and grounds of your
opposition thereto.
The above application will be heard at the Magistrate's
Court, District at on
the day of at o'clock
in the noon and you are hereby notified that
if you fail to lodge such answer within the time herein
prescribed, or to appear at the time and place herein
stated for the hearing of the application such order may be
made against you as may be just and expedient,

Clerk
Magistrate's Court, District



FORM 4. Reg. 5(b).

APPLICATION FOR COMPENSATION BY OR ON BEHALF
OF DEPENDANTS OF DECEASED MASTER, SEAMAN OR
APPRENTICE.
MONTSERRAT.

In the Magistrate's Court, District

In the Matter of the Workmen's Compensation
Ordinance, 1957.
and

In the Matter of an Application by or on behalf of
Dependants of Deceased Master, Seaman, or Apprentice.







Between


E.F. Applicant
and
The Owners of the ship Respondents.
and
G.B.
(or as the case may be; see Reg. 4)

1. On the day of personal
injury by accident-arising out of and in the course of his
employment was caused to A.B.
late of deceased, the master
of the ship (or a seaman, or an
apprentice to the sea service) and a member of the crew of
the ship and on the
day of the death of the said
A.B. resulted from the injury.
OR

1. The ship which left the
port of was lost with all hands
on or about the day of
(or was last heard of on or about the day
of and is believed to have been
lost with all hands).

2. A question has (or questions have) arisen
(here state the questions, specifying only those
which have arisen, e.g.) -
(a) as to whether the said A.B.
was a workman within the meaning of the abovemen-
tioned Ordinance; or
(b) as to the liability of the owners of the said
ship to pay compensation under the abovementioned
Ordinance to the dependants of the said A.B.
in respect-of the injury caused
to them by the death of the said A.B.
or

(c) as to the amount of compensation payable by
the owner of the said ship to the dependants of the
said A.B. under the
abovementioned Ordinance in respect of the injury
caused to them by the death of the said A.B.
: or

(d) as to who are dependants of the said A.B.
within the meaning of the
abovementioned Ordinance; or
(e) as to the apportionment and application of
compensation payable by the owners of the said ship
to the dependants of the said A.B.







in respect of the injury caused to them by the death
of the said A.B.
(or as the case may be).
3. An inquiry under the abovementioned Ordinance is
hereby requested between E.F.
the legal personal representative of the said A.B.
(or between E.F. a dependant
of the said A.B. ) and the
onwers of the said ship, and G.B.
who claims or may be entitled to claim as a dependant of
the said A.B.

4. Particulars are hereto appended (or annexed).
Particulars.
1. Name and address of
master, seaman or appren-
tice.

2. Name of ship of which
deceased was master (or of
the crew of which deceased
was a member) at time of
accident or loss of ship, and
port of registry.
3. Such other particulars as are contained in paragraphs
3 to 13 in Form 2 of this Schedule as may be applicable.

The names and addresses of the applicant and his
solicitor are:

Of the Applicant, '
Of his Solicitor,
The names and addresses of the respondents to be served
with this application are:

As representing the owners of the ship
(State name and address of managing owner or manager,
or of master of ship. See reg. 5(6) )
and G.B.

Dated this day of
Applicant,
or (Applicant's Solicitor).
NOTICE
To of
You are hereby required if you intend to oppose the
above application to lodge with me the undersigned clerk
within seven days after the service of this notice upon you







(or within such extended period as the magistrate may
allow) a written answer to the application containing a
concise statement of the extent and grounds of your
opposition thereto.
The above application will be heard at the Magistrate's
Court, District at on
the day of
at o'clock in the noon and you are
hereby notified that if you fail to lodge such answer within
the time herein prescribed, or to appear at the time and
place herein stated for the hearing of the application such
order may be made against you as may be just and
expedient.
Clerk,
Magistrate's Court, District


FORM 5. Reg. 8.

NOTICE OF CLAIM,

MONTSERRAT,
In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957,

and

In the Matter of an Application by,
for compensation.
Between
A.B. Applicant
and
C.D. Respondent.
Whereas a claim for compensation has been made to
the magistrate by applicant,
against and the said
has claimed that you are
liable under section 25(2) to indemnify him against any
compensation which he may be liable to pay in respect of
the aforesaid claim, you are hereby informed that you may
appear before the magistrate at o'clock on the
day of at
and contest the claim for compensation made by the said
applicant or the claim for indemnity made by the respond-
ent. In default of your appearance you will be deemed to
admit the validity of any award made against the respond-
ent and your liability to indemnify the respondent for any
compensation recovered from him.







I hereby require you to file with the undersigned clerk
a written statement dealing with the claim against you in
the above application within ten days after the service
thereof on you.
And further take notice that if you fail to forward
such statement in writing, an order may be made against
you in default.
Dated this day of 19
Clerk,
Magistrate's Court, District


FORM 6


Reg. 11.


NOTICE OF HEARING.
MONTSERRAT.
In the Magistrate's Court, District
In the matter of the Workmen's Compensation
Ordinance, 1957
and
In the matter of an Application by a Workman J
Compensation.
Between


and


C.D..
Take notice that the Magistrate, District
proceed with the hearing of the application in
at on the
at the hour of


Dated this


noon.
day of


Clerk,
Magistrate's Court, District


Applicant

Respondent.
will
this matter
day of
o'clock in

19


NOTICE OF HEARING TO BE SENT TO RESPONDENT.
Take notice that the Magistrate will proceed with the
hearing of the application in this matter at
on the day of at the
hour of o'clock in the noon, and that
if you do not attend at the time and place above-
mentioned such order will be made and proceedings
taken as the Magistrate may think just and expedient.


Dated this


day of


Clerk,
Magistrate's Court, District


A.B.


the


for









Order.

In the case of application for weekly or half-monthly
payment of compensation.

MONTSERRAT.

In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957
and
In the Matter of an Application by a. Workman for
Compensation.
Between
A.B. Applicant
and
C.D. Respondent.

Upon the application of
and upon hearing
(Here insert any other introductory recital of findings on
which the order is made which the Magistrate may
think fit.)

It is ordered as follows:-

1. That the respondent C.D.
to pay to the applicant A.B.
the weekly (or half-monthly) sum of $ as com-
pensation for personal injuries caused to the said A.B. on
the day of by injury arising
out of and in the course of his employment as a workman
employed by the said respondent, such weekly (or half-
monthly) payment to commence as from the day
of and, to continue during the total
or partial incapacity of the said A.B. for work, or until the
same shall be ended, diminished, increased or redeemed in
accordance with the provisions of the Ordinance.
2. And that the said C.D.
do forthwith pay to the said A.B.
the sum of $ being the amount of such weekly
(or half-monthly) payments calculated from the
day of until the day of
and do thereafter pay the said
sum of $ to the said A.B.
on the and days of each month.

3. And that the said C.D.
do pay to the applicant his costs of and incidental to this
application fixed at the sum of $ (or to be
taxed in accordance with the proper scale).


FORM 7.


Reg. 15(3)







Dated this day of 1&

Magistrate, District



FORM 8. (Reg. 15(3)

Order.

In the case of Application by Dependents.

MONTSERRAT.

In the Ma.gistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957

and
In the Matter of an Application by Dependants.
Between
A.B. Applicant
and
C.D.. Respondent.

Upon the application of
and upon hearing
(Here insert any other introductory recital of findings on
which the order is made which the Magistrate may
think fit.)

It is ordered as follows:-

1. That the respondent C.D. 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 the injury caused to the said
A.B. on the day of by
accident arising out of and in the course of his employ-
ment as a workman employed by the said respondent.

2. And it is declared that the persons hereinafter
named are entitled to share in such compensation as
dependants of the said A.B., that is to say J.B. widow of
the said A.B. and
(name the other persons).

3. (Add if so found) and it is declared that G.H. the
of the said A.B. is not entitled
to share in such compensation as a dependant of the
said A.B.







And it is further ordered.--


4. That the said sum of $ be apportioned
between the said J.B. and proportions
following, that is to say:-
The sum of $ to and for the benefit of
the said J.B. and the sum of $ to and for the
benefit of the said
5. That the said C.D. do pay the said sum of
$ within 14 days from the date of this order.
6. That the said J.B. and the said
or any of them be at liberty to apply to the Magistrate
from time to time for any further or other order as to the
application of any of the said sums which may be ordered
to be invested and the accruing interest thereof.
7. That the said C.D. do pay to the applicants their
costs of and incidental to this application fixed at the sum
of $ (or to be taxed in accordance with the
proper scale).

Dated this day of 19
Magistrate, District


FORM 9 Reg. 15(3)
Order.

In case of Application by Persons to whom Expenses of
S medical attendance and burial are due.

MONTSERRAT.

IN THE MAGISTRATE'S COURT, DISTRICT
In the Matter of the Workmen's Compensation
Ordinance, 1957
And
In the Matter of an Application by persons to whom
expenses of medical attendance and burial are due.
Between
A.B. Applicant
and
C.D. Respondent.
Upon the application of
and upon hearing
(Here insert any other other introductory recital of
findings on which the order is made which the Magistrate







may think fit).

It is ordered as follows:-

1. That the respondent C.D. do pay the sum of
$ for or towards the expenses of medical
attendance and burial of A.B. late of
deceased, who died on the day of
from injury caused on the day of
by accident arising out of and in the course of the employ-
ment of the said A.B. as a workman employed by the
said C.D.

2. And it is declared that the persons hereinafter
named are entitled to share in such compensation, that is
to say:-

The applicant E.F. in respect of charges amounting to
$ due to (or payable by) him for medical
attendance and burial of the said A.B.

Dated this day of 19

Magistrate, District


FORM 10. Reg. 23(2)

APPLICATION FOR ORDER FOR DETENTION OF SHIP.
IN THE SUPREME COURT OF THE WINDWARD ISLANDS
AND LEEWARD ISLANDS.

Montserrat Circuit.

IN THE MATTER OF THE WORKMEN'S COMPENSATION
ORDINANCE, 1957.

THE SHIP "
Application is hereby made on behalf of
of who alleges
that the owners of the ship which
has been found in the port of (or within
three miles of the coast of the Colony), are
liable to such owners to pay compensation under the above-
mentioned Ordinance, in respect of personal injury by
accident arising out of and in the course of his employ-
ment caused to of
on the day of
in the port (or harbour) of and
who claims compensation in respect of such injury, and
alleges that none of the owners of the said ship reside in
the Colony for an order directed to an officer of Customs
or other officer named by the judge, requiring him to







detain the said ship until such time as to the owners, agent,
master, or consignee thereof have paid such compensation,
or have given security, to be approved by the judge, to
abide the event of any proceedings that may be instituted
to recover such compensation, and to pay such compensa-
tion and costs as may be awarded thereon, or until the
said ship shall be otherwise released by due course of law.
The grounds on which this application is made are set
forth in the affidavit of filed herewith
(or will be given in evidence on the hearing of the
application).
Dated this day of
(Name and address of Applicant or
Applicant's Solicitor).


FORM 11. Reg. 23(3)

UNDERTAKING AS TO DAMAGES.
IN THE SUPREME COURT OF THE WINDWARD ISLANDS
AND LEEWARD ISLANDS,
Montserrat Circuit.
IN THE MATTER OF THE WORKMEN'S COMPENSATION
ORDINANCE, 1957.

The Ship "
I, the undersigned of
hereby undertake to abide
by any order which may hereafter be made as to damages,
in case any person affected by the order to be made on my
application for the detention of the ship "
shall sustain any damages by reason of such order which I
ought to pay.

Dated this day of 19
(Signature and Address of Applicant).
(To be altered as required, if the undertaking is given-by
any person other than the applicant).


FORM 12. Reg. 23(4)

ORDER FOR DETENTION OF SHIP.
IN THE SUPREME COURT OF THE WINDWARD ISLANDS
AND LEEWARD ISLANDS,
MONTSERRAT CIRCUIT.
IN THE MATTER OF THE WORKMEN'S COMPENSATION
ORDINANCE, 1957.
The Ship "
Whereas it is alleged that the owners of the ship
are liable as such owners







to pay compensation in respect of personal injury by
accident arising out of and in the course of his employ-
ment caused to in the
port of (or harbour) of
And that the said ship has been found in the port of
(or within three miles of the coast
of the Colony):
And whereas it has been shown to me, on the applica-
tion of of
who claims compensation in respect of such injury, that
the owners of the said ship are probably liable as such to
pay such compensation, and that none of the owners reside
in the Colony:
(And whereas the said
has filed an undertaking to abide by any order which may
hereafter be made as to damages, in case any person
affected by this order shall sustain any damages by reason
of this order which the said
ought to pay):
Now I do hereby issue this order directed to you, the
Collector of Customs at
(or other officer named by the judge) requiring you to
detain the said ship until such time as the owners, agent,
master or consignee thereof have paid compensation in
respect of the said injury, or have given security in the
sum of $ to be approved by the judge, to
abide the event of any proceedings that may be instituted
to recover such compensation, and to pay such compensa-
tion a.nd costs as may be awarded thereon, or until the
said ship shall be otherwise released by due course of law.
Dated this day of
Judge.
To the Collector of Customs at
(or other officer named by the judge).



FORM 13 Reg. 23(6).
Bond by way of Security.
IN THE SUPREME COURT OF THE WINDWARD ISLANDS
AND LEEWARD ISLANDS.
MONTSERRAT CIRCUIT.
In the Matter of the Workmen's Compensation
Ordinance, 1957.

The Ship "
Whereas it is alleged that the owners of the ship







are liable as such owners
to pay compensation in respect of personal injury by
accident arising out of and in the course of his employment
caused to of
in the port (or harbour)
of

And whereas the judge of this Court has issued an
order directed to the Collector of Customs at
(or other officer named by the judge),
requiring him to detain the said ship until such time as the
owners, agent, master, or consignee thereof have paid
compensation in respect of the said injury, or have given
security in the sum of $ to be approved by
the judge, to abide the event of any proceedings that may
be instituted to recover such compensation, and to pay
such compensation and costs as may be awarded thereon,
or until the said ship shall be otherwise released by due
course of law:
Now, thereof, we (state names, addresses, and descrip-
tions of sureties) jointly and severally submit ourselves to
the jurisdiction of this Court, or of any other competent
Court in the Colony in which any proceedings may be insti-
tuted in respect of the said injury, and consent that if the
owners, agent, master, or consignee of the said ship shall
not pay all such compensation and costs as may be awarded
thereon execution may issue forthwith against us, our
heirs, executors and administrators, goods and chattels,
for a sum not exceeding dollars.
(Signature of Sureties).

This bail bond was signed by the said
and the
sureties, the day of
Before me,
Registrar of the Supreme Court.


FORM 14. Reg. 23(7)

ORDER OF RELEASE.

IN THE SUPREME COURT OF THE WINDWARD ISLANDS
AND LEEWARD ISLANDS.
Montserrat Circuit.
IN THE MATTER OF THE WORKMEN'S COMPENSATION
ORDINANCE, 1957.

The Ship "
You are hereby authorised and directed to release the
614] now under detention






by virtue of an order made on the day of
upon the payment of all costs,
charges and expenses attending the custody thereof.
Dated this day of
Judge.
To the Collector of Customs at
(or other officer named in
the order for detention).


FORM 15 Reg. 23(8)(b)
SOLICITOR'S UNDERTAKING TO GIVE SECURITY.

IN THE SUPREME COURT OF THE WINDWARD ISLANDS
AND LEEWARD ISLANDS,

MONTSERRAT CIRCUIT.

IN THE MATTER OF THE WORKMEN'S COMPENSATION
ORDINANCE, 1957.

The Ship "
Whereas it is alleged that the owners of the ship
are liable as such owners
to pay compensation in respect of personal injury by
accident arising out of and in the course of his employment
caused to of
in the port (or harbour)
of

Now, therefore, I, L.M. of






solicitor for the owners (agent, master or consignee) of the


said ship, hereby undertake within days from
the date hereof to give security in the sum of'$
to be approved by the judge, to abide the event of any
proceedings that may be instituted to recover such com-
pensation and to pay such compensation and costs as may
be awarded thereon.

Dated this day of


(Signed) L.M,









APPLICATION FOR COMPENSATION WHERE SECURITY
HAS BEEN GIVEN ON BEHALF OF THE OWNERS OF A
SHIP UNDER SECTION 34.

MONTSERRAT.

IN THE MAGISTRATE'S COURT, DISTRICT

In the Matter of the Workmen's Compensation
Ordinance, 1957.

and

In the Matter of an Application for Compensation
where Security has been given on behalf of the
Owners of a ship under section 34.
Between
A.B. Applicant
and
(Name and addresses of persons giving security)
Respondents.

1. On the day of personal
injury by accident arising out of and in the course of his
employment was caused to. A.B.
of and the said A.B. claims
that the owners of the ship "
are liable under the abovementioned Ordinance to pay
compensation in respect of the said injury.
2. The respondents have given security to abide the
event of any proceedings that may be instituted in respect
of the said injury and to pay such compensation and costs
as may be awarded thereon.

3. A question has (or questions have) arisen
(here state the questions, specifying only those
which have arisen; e.g.) -

(a) as to whether the said A.B.
is a workman to whom the abovemen-
tioned Ordinance applies; or

(b) as to the liability of the owners of the ship to
pay compensation under the abovementioned Ordi-
nance in respect of the said injury; or

(c) as to the amount (or duration) of the com-
pensation payable to the said A.B.
under the abovementioned Ordinance in respect of the
said injury (or as the case may be)


FORM 16


Reg. 23(9)







4. An inquiry under the abovementioned Ordinance is
hereby requested between the said A.B.
and the respondents for the settlement of the said question
(questions).

5. Particulars are hereto appended (or annexed).
Particulars.
(Here insert particulars of circumstances under which
the application is made, and of the relief or order
which the applicant claims, adapting the particu-
lars to the circumstances of the case).
The names and addresses, etc. (as in Form 2A).

NOTE: This form to be adapted as required to an applica-
tion for compensation as between the dependants
of a deceased workman and the persons giving
security,


FORM 17. Reg. 24.
Memorandum of Agreenent in case of a non-fatal injury
to workman by accident,
MONTSERRAT.

In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957.
and
In the Matter of an Agreement
Between
A.B. Applicant
and
C.D. Respondent.
1. Be it remembered, that on the day of
personal injury was caused at
to the abovenamed
,a workman under no legal disability,
(or a minor of the age of years) by accident
arising out of and in the course of his employment.
2. (Here insert the like particulars as in Form 1).

3. And that on the day of
the following agreement was come to by and between the
said

(here set out terms of agreement)
4. (If a medical referee has been appointed to report,
add)








A copy of the report of Mr.
a medical referee appointed to report in the abovemen-
tioned matter is hereunto annexed.

5. You are hereby requested to record this memoran-
dum, pursuant to section 21 of the abovementioned
Ordinance.
Dated
Signature of Employer
Witness
Signature of Workman
Witness

Note: An application to record an agreement can be pre-
sented under the signature of one party only pro-
vided that the other party has agreed to the
terms. Both signatures should be appended,
whenever possible.

To the Clerk, Magistrate's Court, District



FORM 18 Reg. 24.

Memorandum of Agreement Where death resulted from
the injury to the Workman.

MONTSERRAT.

In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957.
and

In the Matter of an Agreement
Between
A.B. Applicant
and
C.D. Respondent.
1. Be it remembered, that on the day of
personal injury was caused at
to
late of deceased, by accident
arising out of and in the course of his employment, and
that on the day of the said
died as a result of
such injury.

2. (Insert here like particulars as in Form.2).






3. And that on the day of
the following agreement was come to by and between
the dependants of the
said within the meaning
of the abovementioned Ordinance, and the said
that is to say:
(here set out terms of agreement)

4. (If a medical referee has been appointed to report,
add)
A copy of the report of Mr.
a medical referee appointed to report in the abovemen-
tioned matter is hereunto annexed.

5. You are hereby requested to record this memoran-
dum pursuant to section 21 of the abovementioned
Ordinance.

Dated
Signature of Employer
Witness
Signature of Workman
Witness

Note: An application to record an agreement can be
presented under the signature of one party only
provided that the other party has agreed to the
terms. Both signatures should be appended, when-
ever possible.

To the Clerk, Magistrate's Court, District


FORM 19 Reg. 25.

Notice to Parties before Memorandum of
Agreement is recorded.

MONTSERRAT.
In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957.
and
In the Matter of an Application to record Memorandum
of Agreement.
Between
A.B. Applicant
and
C.D. Respondent.
Whereas agreement to pay compensation is said to
have been reached between
and






And whereas has/have
applied to the Magistrate for registration of the agreement
under section 21(3) notice is hereby given that the said
agreement will be taken into consideration by the Magis-
trate at o'clock on the day of
at and that any objection to
the registration of the said agreement should be made on
the date and at the place aforesaid. In the absence of
valid objections it is the Magistrate's intention to proceed
to the registration of the agreement.

Dated 19
Clerk,
Magistrate's Court, District



FORM 20. Reg. 27 & 29.

Application for review or redemption of weekly
or half-monthly payment.

MONTSERRAT.

IN THE MAGISTRATE'S COURT, DISTRICT
In the Matter of the Workmen's Compensation
Ordinance, 1957,

and

In the Matter of an Application for review or redemption
of weekly or half-monthly payment.
Between
A.B. Applicant
and
C.D. Respondent.

Application is hereby made for the review (termina-
tion, diminution, increase or redemption, as the case may
be) of the weekly (or half-monthly) payment payable to
the said in respect of
personal injury caused to him by accident arising out of
and in the course of his employment, on
at in the Colony of Montserrat.

Particulars are hereto appended:-
Particulars.

1.. Name and address of in-
jured workman.






2. Name and place of busi-
ness of- employer by whom
compensation is payable.
3. Date and nature of acci-
dent.
4. Amount of weekly (or
half-monthly) payment, and
date from which it com-
menced.

5. Relief sought by appli-
cant, whether termination,
diminuition, increase or re-
demption.

6. Grounds of application.

Dated this day of 19
Applicant.
To the Magistrate, District



FORM 21. Reg. 30,
Application for Order for Payment to Defendant
or other person of weekly (or half-monthly)
payment payable to person under disability,
MONTSERRAT.
IN THE MAGISTRATE'S COURT, DISTRICT
In the Matter of the Workmen's Compensation
Ordinance, 1957,
and
In the Matter of an Application for Order for payment
to dependant or other person of weekly or half-monthly
payment payable to person under disability.
Between
A.B. Applicant
and
C.D. Respondent.
Take notice that I (name and address of applicant)
intend to apply to the Magistrate, District on the
day of for an order that the weekly (or
half-monthly) payment payable in the abovementioned
matter to a person under
legal disability (or to me) be during his (or my) disability
be paid to (name) a dependant or to any other person best
fitted to provide for the welfare of the said (name of
workman under disability) and for consequential directions.







Applicant.

To the Clerk, Magistrate's Court, District and to,
(names of all parties interested).


FORM 22 Reg. 31.

Application for Variation of Order.

MONTSERRAT.
In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957,
and
In the Matter of an Application for Variation of Order.
Between
A.B. Applicant
and
C.D. Respondent.
Take notice that I (name and address of applicant)
intend to apply to the Magistrate, District on the
day of for an order that the order
of the Magistrate made in the abovementioned matter on
the day of as to the dis-
tribution of the sum paid as compensation among the
dependants of dece, sed
(or as to the manner in which the sum payable to
a dependant of
deceased, should be applied
or otherwise dealt with) may be vai led
by directing (here state variation sought by applicant)
and for consequential directions.
And further take notice that the circumstances in
which this application is made are -
(state particulars)

Dated this day of
Applicant.

To the Clerk, Magistrate's Court, District and
to (names of all persons interested.)


FORM 23. Reg. 33.
Deposit of Compensation for Fatal Accident.
MONTSERRAT.
In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957,


bated this


day of







and
In the Matter of a Deposit of Compensation for Fatal
Accident.
Compensation amounting to $ is hereby
presented for deposit in respect of injuries resulting in
the death of residing at
which occurred on
at
His monthly wages are estimated at
He was over/under 17 years at the time of his death.
The said workman had, prior to the date of his death,
received the following payments, namely:-
Dated 19
Employer.
(To be added if I desire to be made a party to the
desired) proceedings for the distribution of
the aforesaid compensation.
Employer.
(State name and addresses of dependants so far known)


FORM 24 Reg. 33(4)
Statement of Disbursements.

MONTSERRAT.
In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957,
and
In the Matter of a Statement of Disbursements.
Depositor
Amount deposited
Date


Funeral expenses paid

Compensation paid to the following
dependants -
Name Relationship


....................... ............................ .....

........ ... *** ..........o........ ..** ....**********.
Total

Dated 19
Magistrate,








Deposit of Compensation for non-fatal Accidents.

MONTSERRAT.

In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957,
and
In the Matter of a Deposit of Compensation for non-fatal
Accidents.
Compensation amounting to $ is hereby
presented for deposit in respect of permanent/temporary
injuries sustained by
residing a.t which
occurred on

Dated 19

Employer,



FORM 26 Reg, 35(2)
Reference to Medical Referee under section
36(2)(i),
MONTSERRAT.

In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957,
and
In the Matter of a Reference to a Medical Referee.
Between
A.B. Applicant
and
C.D. Respondent

I, Magistrate, District
having heard the evidence tendered by both
parties, hereby certify that in my opinion the medical evi-
dence given before me is conflicting (or insufficient) on a.
matter which seems to me to be material to a question
arising in the abovementioned application, and it is
desirable to obtain a report from a medical referee on such
matter, as follows:

(a) On the day of
personal injury was (or is alleged to have been) caused to


FOtM 25.


Reg. 34.







ti)
by accident arising out of and in the course of his em-
ployment, under the following circumstances:-
(2)
OR in the case of an occupational disease to which the
Ordinance applies -

(A) On the day of the
said (1) was under section 23,
certified to be disabled by or suspended from his usual
employment on account of his having contracted, a disease
to which the said section applies, namely:-

(B) The matter on which I am satisfied that it is
desirable to obtain a report is -

(C) Such matter seems to be material to the follow-
ing question arising in the application, viz:-

I therefore appoint (4)
one of the medical referees appointed by the Governor for
the purposes of the abovenamed Ordinance, to examine
the said (1) on the
matter specified above, and to report to me.

A statement of the medical evidence given before me
is appended.

I am satisfied that the said (1)
who is now at
is in-a fit condition to travel for the purpose of being
examined, and he has been directed to attend on the
referee for examination at such time and place as shall be
fixed by the referee; or does not appear to be in a fit con-
dition to travel for the purpose of being examined.

The referee is requested to forward his report to the
Magistrate, District at
on or before the day of

Dated this day of

Magistrate, District
A previous reference was made to a medcial referee in
this case on the day of and a
copy-of the report thereupon given is attached.

(1) Insert name of injured workman.
(2) Here state the facts of the accident as ascertained
from the evidence.
(3) Name disease to which the section applies.
(4) Here insert name of medical referee.









Order on Iujured Workman to submit himself for
examination by medical referee.

MONTSERRAT.
In the Magistrate's Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957,
and
In the Matter of an Order on Injured Workman to submit
himself for examination by Medical Referee.
To of
TAKE NOTICE that Dr. of
one of the medical referees
under the Workmen's Compensation Ordinance, 1957, has
been appointed to examine you for the purposes of the
abovementioned matter and to report (or issue his
certificate)
You are hereby required to submit yourself for
examination by such referee *and to attend for that pur-
pose at such time and place as may be fixed by him.
Dated this day of
Magistrate, District


FORM 28. Reg. 36(1)
Order of reference to medical referee under section 47.
MONTSERRAT.
In the Magistrate Court, District
In the Matter of the Workmen's Compensation
Ordinance, 1957
and
In the Matter of a reference to a medical referee
Between
A.B. Applicant
and
C.D. Respondent.
On the application of A.B.
of and C.D. & Co., Limited, of
(a copy of which is hereto
annexed), I hereby appoint Dr.
of
one of the medical referees appointed by the Governor for
the purposes of the Workmen's Compensation Ordinance,

Strike out from "and to attend" when injured workman does not
appear to be in a fit condition to travel.


FORM 27.


Reg. 35(4)







1957, to examine the said
and to give his certificate as to the condition of the
said and
his fitness for employment stating whether the said
has wholly or partially
recovered from the injury (or occupational disease) and
specifying if necessary the kind of employment for which
he is fit (or his certificate whether (or to what extent) the
incapacity of the said
is due to the accident (or his certificate as to the condition
is due to the accident) of the said
and his fitness for employment, stating whether the said
has wholly or partially
recovered from the injury (or occupational disease) and
specifying if necessary the kind of employment for which
he is fit, and as to whether (or to what extent) the
incapacity of the said
is due to the accident).

Copies of the reports of the medical practitioners by
whom the said has been
examined are hereto annexed.

The said who is now
at has been directed to submit
himself for examination by the referee.

I am satisfied that the said
is in a fit condition to travel for the purpose of being
examined, and he has been directed to attend on the
referee for examination at such time and place as may be
fixed by the referee.

(OR The said does not
appear to be in a fit condition to travel for the
purpose of being examined).

The referee is requested to forward his certificate to
the Magistrate at the Magistrate's Court, District
situate at on or before the
day of 19

Dated this day of 19

Magistrate.

Note: Where only one party is the applicant this form
shall be used with the necessary modifications.







FORM 29. Reg. 36(3)

Certificate of medical referee under section 47.

MONTSERRAT.

In the Magistrate's Court, District

In the Matter of the Workmen's Compensation
Ordinance, 1957,
and
In the Matter of a Certificate of medical referee.

In accordance with the reference made to me on
(date of Order of Reference) by the Magistrate, Dis-
trict upon the application of (name and address
of party or parties) I have on the day of
examined (name of workman)
and I hereby certify that:
1. The condition of the said
(name of workman) is as follows:-
(Describe condition of workman, stating whether
he has wholly or partially recovered see footnote -
from the injury by accident or occupational disease
and stating whether workman is fit for his ordinary
or other work, specifying where necessary the kind of
work, or whether he is unfit for work of any kind).
2. The incapacity of the said
(name of workman). (State whether the incapacity has
ceased or to what extent, if any, the incapacity is due to
the accident or occupational disease).

Dated this day of
Medical Referee.

FOOTNOTE

Either paragraph 1 or paragraph 2 to be filled up, or both to be
filled up, according to the terms of the Reference.
In dealing with the question of recovery, if the referee finds that
the workman is no longer physically incapacitated for work as a result
of the accident or of the attack of the disease, but that the workman's
condition is such that either (a) there is a reasonable probability of the
workman becoming again incapacitated through the effects of the
accident or through a recrudescence of the attack of the disease, or (b)
there is, as a result of the attack, an increased susceptibility to a fresh
attack of the disease, the referee should include a statement as to his
findings.
If the Order of Reference and the documents which accompanied
it show that the decision of the Referee is desired as to the workman's
condition or fitness for employment (or as to whether or to what
extent his incapacity was due to the accident) at some date previous
to the date of the Referee's examination (see section 13), the Referee
should deal with this point also, so far as he can.









Notice by Medical Referee to Injured Workman
under section 36(2)(i)

Workmen's Compensation Ordinance, 1957.

MONTSERRAT.

In the Magistrate's Court, District
To of

I hereby give you notice that I have been appointed to
report on your case under section 36(2)(i) of the above-
named Ordinance, and that I propose to examine you at
on the day of
at o'clock and you are
required to submit yourself for examination accordingly.

Dated this day of

Medical Referee.



FORM 31. Reg. 38.

Notice by Medical Referee to Workman in case
of a referee under section 47(2).
Workmen's Compensation Ordinance, 1957.

MONTSERRAT.

In the Magistrate's Court, District

To of
I hereby give you notice that in accordance with the
Reference made to me in your case by the Magistrate,
District holden at under
section 47(2) of the abovenamed Ordinance, I propose to
examine you at on the
day of at o'clock.

And you are required to submit yourself for examina.-
tion accordingly.

Any statements made or submitted by you will be
considered.

Dated this day of 19
Medical Referee.


PORM 30.


Reg. 38.











Notice by Medical Referee to Employer in case of a
reference under section 47(2).
Workmen's Compensation Ordinance, 1957.

MONTSERRAT.
In the Magistrate's Court, District
To of
I hereby give you notice that in accordance with the
Reference made to me by the Magistrate, District
holden at under section 47(2) of the
abovenamed Ordinance, in the case of
(name and address of workman) I
propose to examine the said
at on the day of


at o'clock.
Any statements made or submitted by
considered.


SDated this


you will be


day of

Medical Referee.


SCHEDULE B.

PART 1.

Remuneration and other Expenses
Referee Workmen's Compensation
1957.

(a) For- examination of workman,
issue of certificate and all other
duties performed by a medi-
cal referee in relation to a refer-
ence under section 36(2) or
section 47
(b) Where a medical referee has to
travel a distance of more than
two miles from his office or resi-
dence to examine a workman
pursuant to a reference


tr
p
tc
e!
m
le
fo
TO


Reg. 39.

of Medical
Ordinance,


a sum equal to the
ravelling allowances
aid by Government
officers in their
nployment with a
minimum sum equiva-
nt to the allowance
>r travelling two
iles,


?


C"-






.,; *- .







r '
F '. '



I'' "'

::
r


Reg. ,


FORM 32.


.







PART IT.

FORM 1.

Form of Application for registration by employers
to whom section.24 applies.

Workmen's Compensation Ordinance, 1957.

1. Name of employer

2. Place of business of em-
ployer

3. Name of insurance com-
pany with which employer
is ensured and number of
date of each policy

4. Type of risks against
which employer is insured

5. Nature of employment
in which workmen are
engaged

6. Approximate number of
workmen employed
7. Total sum assured


FORM 2. Reg. 41(2)

Certificate of Registration under
section 26

of the

Workmen's Compensation Ordinance, 1957

This is to certify that

M ............... ....... ................... ...o....o *'

of.......................... ........ .. ... .... ...*.

carrying on the business or trade mentioned hereunder
has been registered by me in accordance with section 26.
of the Workmen's Compensation Ordinance, 1957,



51' z








Type of Average Number of and In-
Business Location. number persons surance
or Trade. employed. covered by Policy No.
Insurance.












This certificate shall be posted in a conspicuous place
for workpeople to see.

............................................
Commissioner of Labour.

D ate................................................. ..... ... ..



PART III.

Solicitors costs and allowances to parties and witnesses.
Workmen's Compensation Ordinance, 1957.

(1). Solicitors Fees
$ cts.
(a) In uncontested claims for com-
pensation 6
(b) In contested claims for compen-
sation -
(i) where the sum is in
dispute does not ex-
ceed $100 12
(ii) exceeds $100 but does
not exceed $400 16
'(iii) exceeds $400 -
$16 for the first
$400 and $6 for
succeeding $400 or
part thereof.
(For the purpose of this Part of this Schedule
the expression "sum in dispute" means, where
costs are awarded to a successful applicant,
the sum recovered, and, wherever costs are
awarded to a successful respondent, the sum
claimed).







(c) Fee on adjourned hearing, if
allowed
(d) Preparation and registration of
a Memorandum of Agreement.
(e) Applications for review or re-
demption
(f) Attendance to file any document
with the clerk

(g) Appeals from a Magistrate to a
Judge of the Supreme -Court

(h) Special cases


(i) Any matter not provided for in
this Part of this Schedule


$ cts.


Such fees as may
be allowed within
the limits authorised
Sby the Magistrate's
ICode of Procedure
J Act.

Such reasonable costs
as may be allowed
by the Magistrate.


(2) Allowances to Parties and Witnesses.


(a) Medical Practitioners, planters,
merchants, bankers, government
officers and professional persons,
not exceeding per diem
(b) Agricultural labourers, domestic
servants, day labourers and the
like persons, not exceeding
per diem
(c) Other persons, according to their
rank, in life, not exceeding
per diem
And any actual travelling
expenses allowed by the Magis-
trate.


$ cts.


2 40


1 00

1 50


PART IV.


Reg. 43.


Medical Practitioners Fees under section 6(2)(a)

Workmen's Compensation Ordinance, 1957.


(a) Where a workman is examined
at a medical practitioner's office
or surgery between 7.00 a.m.
and 7 p.m.


$ cts.


3 00







(b) Where a workman is examined at
a medical practitioner's office or
surgery between 7 p.m. and
7.00 a.m.

(c) Where a medical practitioner is
required to examine a workman
at a place other than his office
or surgery between the hours of
6.30 a.m. and 7 p.m.

(d) Where a medical practitioner is
required to examine a, workman
at a place other than his office
or surgery between the hours of
7 p.m. and 7.00 a.m.


4 00




4 00




5 00


PART V.

Fees of Court,


Workmen's Compensation Ordinance, 1957.

1. Applications for compensation -


$ cts.
(a) Where compensation is claimed
in the form of recurring
payments 1 50

(b) Where compensation is claimed
in the form of lump sum $1.00 where the
sum does not ex-
ceed $250, plus
$1.50 for each
additional sum of
$250 or fraction
thereof.
(2) Applications for redemption -
$ cts.


(a) By agreement between the parties
(b) In all other cases

(3) Applications for the deposit
of compensation -
(a) Under section 15(1) of the Ordinance
(b) In all other cases, in respect of
each person to whom compensa.-
tion is payable








4. Applications for distribution
by dependants, for each dependant
5. Applications for review -
(a) Where the review claimed is the
continuance, increase, decrease,
or ending of weekly or half-
monthly payments
(b) Where the weekly or half-
monthly payments are sought to
be converted into a lump sum
(c) In all other cases
6. Application for the registra-
tion of agreements -

(a) Where the application or the
memorandum of agreement is
signed by both parties
(b) In all other cases


7. Application to summon witnesses -
For every. witness
8. Applications for indemnification
9. Applications for the recovery
compensation -
i Under an order already made by
the Magistrate
SIn all other cases Th


10. All applications not other-
wise provided for
11. Answer to any claim
12. Notice of motion for appeal
from Magistrate to a Judge
13. Filing any document not
otherwise provided for
14. Copy of any document fur-
nished by the clerk
15. (a) For service of any notice
or persons
(b) For service at a greater
distance than two miles
from the Magistrate's
office, for every extra
mile or part of a mile
in addition to the above
fee
Provided that mileage
shall be calculated to a
place, and not to and
from a place.


1 50



1 50


$ cts.

75
1 50

25
3 00


e same


payable on
application
pensation.


50
fee as is
a similar
for com-


$ cts.
50
50

3 00

25

4c. per folio

15





06


A Utigua Printery .4t4.


I




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