Application for weekly payments after the second entitlement period

Injured workers who believe they have an ongoing entitlement to receive weekly payments after the second entitlement period can use this form to apply for these payments.

Shape
 
Published: 01 Mar 2017
 
File type: PDF
 
File size: 96.35 kB
 
Length: 2 pages
 
Reading level: Medium

What it contains

A form to be completed to apply for for weekly payments after the second entitlement period. Information to be completed in the form includes:

  • worker details
  • current employment details 
  • authority
  • mandatory attachments required for a valid applicatio
  • other attachments
  • worker declaration