BEFORE THE _________ WORKMENS’ COMPENSATION COURT, _________
_________
VERSUS
_________
Application under the Workmen’s compensation Act For the grant of compensation of _________ /-
Sir,
I, the undersigned do hereby authorize _________, as my Authorised Representatives to conduct the above mentioned case on behalf of me. All the agreements and commitments done by my above said A.R. shall be ratified and confirmed by me.
Dated:Accepted by:
_________, resident of _________,
_________, ________
_________
VERSUS
_________
Application under the Workmen’s compensation Act For the grant of compensation of _________ /-
Authority Letter
Sir,
I, the undersigned do hereby authorize _________, as my Authorised Representatives to conduct the above mentioned case on behalf of me. All the agreements and commitments done by my above said A.R. shall be ratified and confirmed by me.
Claimant
Dated:Accepted by:
_________, resident of _________,
_________, ________
