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.

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Published: 01 Mar 2017

File type: PDF

File size: 96.35 kB

Length: 2 pages

Reading level: Medium

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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

Application for weekly payments after the second entitlement period

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