S.I. No. 286/1953:

WORKMEN'S COMPENSATION (AMENDMENT) ACT, 1953 (PRESCRI BED DECLARATIONS) REGULATIONS, 1953.

WORKMEN'S COMPENSATION (AMENDMENT) ACT, 1953 (PRESCRI BED DECLARATIONS) REGULATIONS, 1953.

I, SÉAMAS Ó RIAIN, Minister for Social Welfare, in exercise of the power conferred on me by subsection (3) of section 10 of the Workmen's Compensation (Amendment) Act, 1953 (No. 25 of 1953), hereby make the following Regulations :

1. These Regulations may be cited as the Workmen's Compensation (Amendment) Act, 1953 (Prescribed Declarations) Regulations, 1953.

2. In these Regulations "the Act" means the Workmen's Compensation (Amendment) Act, 1953 .

3.--(1) Where a declaration is required in accordance with the provisions of subsection (1)(a) of section 10 of the Act it shall be furnished in the Form 1(a) in the Schedule to these Regulations.

(2) Where a declaration is required in accordance with the provisions of subsection (1)(b) of section 10 of the Act it shall be furnished in the Form 1(b) in the Schedule to these Regulations.

SCHEDULE

Form 1(a)

WORKMEN'S COMPENSATION (AMENDMENT) ACT, 1953 .

Form prescribed by the Minister for Social Welfare.

DECLARATION BY A WORKMAN FOR THE PURPOSE OF OBTAINING SUPPLEMENTAL ALLOWANCES.

Name and Address of Employer............................................................ ............................................................ .....

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

1. Surname of Workman............................................................ ............................................................ ...................

2. Full Christian Names of Workman............................................................ ..........................................................

3. Full Address of Workman............................................................ ............................................................ ............

4. Have you a wife, now alive and married to you at the time of the accident, in respect of whom you are claiming a supplemental allowance? If so, give the following particulars:--

5. Particulars of any child or children now alive and under the age of 15 years should be given overleaf.

6. Are you receiving or claiming weekly compensation under the Workmen's Compensation Acts for another injury (accident or disease) from any other employer (or employer's insurer) ? If so, state the name and address of the other employer, and the amounts of the weekly compensation and supplemental allowances which you receive from such employer (or insurer) :--

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

I DECLARE that all the information given above and overleaf is true and correct.

Signature of Workman*.......................................

Date.......................

*Where the workman is unable owing to illness or other reasonable cause, himself to sign the declaration, the wife or other representative of the workman should inform the employer (or his insurer) of the reason why he is unable to sign it and should complete the form so far as practicable.

(REVERSE SIDE)

Give particulars hereunder of your child* or children now alive and under 15 years of age.

*For the purposes of the Workmen's Compensation (Amendment) Act, 1953 , " child " means, in relation to a male workman entitled to a weekly payment :--

(a) any legitimate or illegitimate child born to him not later than ten months after the accident giving rise to compensation,

(b) any step-child, being a legitimate child whose mother was married to him before the accident, and

(c) any child adopted before the accident by him, or by him and his wife jointly, in pursuance of an adoption order made under the Adoption Act, 1952 .

FORM 1(b)

WORKMEN'S COMPENSATION (AMENDMENT) ACT, 1953 .

Form prescribed by the Minister for Social Welfare.

PERIODICAL DECLARATION BY A WORKMAN IN RECEIPT OF SUPPLEMENTAL ALLOWANCES.

1. Surname of workman............................................................ ............................................................ ................

2. Full Christian names of workman ............................................................ .......................................................

3. Full address of workman ............................................................ ............................................................ ..........

4. Name and address of employer on whose behalf the Declaration is required.............................................

5. Is your wife, in respect of whom a supplemental allowance is being paid still alive ? (If not, give the date and place of death) ............................................................ ............................................................ ...................

6. Is the child or each of the children, in respect of whom a supplemental allowance is being paid, still alive ? (Give the name and date and place of death of any child who has died) ...................................................

7. Is the child or each of the children under the age of 15 years ? (Give the name and date and place of birth of any child who has reached the age of 15 years) ............................................................ ..........................

8. Are you receiving or claiming weekly compensation under the Workmen's Compensation Acts for another injury (accident or disease) from any other employer (or employer's insurer) ? If so, state the name and address of the other employer, and the amounts of the weekly compensation and supplemental allowances which you receive from such employer (or insurer) :--

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

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

I DECLARE that all the information given above is true and correct.

Signature of Workman*....................

Date .......................

*Where the workman is unable, owing to illness or other reasonable cause, himself to sign the declaration, the wife or other representative of the workman should inform the employer (or his insurer) of the reason why he is unable to sign it and should complete the form so far as practicable.

GIVEN under my Official Seal, this 31st day of August, 1953.

SÉAMAS Ó RIAIN,

Minister for Social Welfare.