Download Form 2C - Workers Compensation Commission

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(Office use only)
March 2014
FORM 2C
Matter No:
Application
Application to Admit Late Documents
This is the approved form to apply for leave to introduce late evidence or a late reply.
Applicant:
Respondent:
Worker
Employer
Self-insurer
Worker representative
Employer representative
Insurer/scheme agent representative
Dependant
Scheme agent*
WorkCover NSW
Dependant representative
Specialised insurer
*Note scheme agent means scheme agent for the nominal insurer
TMF Agent
Details of proceedings for which late documentation is provided:
Date of teleconference:
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Date of conciliation/arbitration:
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Name of Arbitrator (if known):
Late documents attached to this application: (complete box below)
Document
Form 2C
Date of Document
(in chronological order)
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Start Page
March 2014
Date received (Office use only)
Author
Application to Admit Late Documents
Filed by:
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Service: Date served on other parties:
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Date served on other parties:
Method of service:
Method of service:
Party/person served:
Party/person served:
Address of party/person served:
Address of party/person served:
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Reasons in support of application (addressing Workers Compensation Commission Rules 2011
sections 10.3, 10.4, 11.1 as appropriate):
Form 2C - March 2014
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Signature
Signature of filing party (or representative): _________________________Date:
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Lodgment Details
Hand delivery
Level 20, 1 Oxford Street Darlinghurst NSW 2010
Postal address
PO Box 594 Darlinghurst NSW 1300
Document exchange
DX 11524 Sydney Downtown
Electronic lodgment
[email protected]
Facsimile
1300 368 018
Privacy of Personal Information
The privacy of personal information is important to the Workers Compensation Commission. The
Commission collects personal information to register application forms and make decisions about disputes
or claims. The NSW workers compensation laws permit the Commission to collect this information.
The Commission may give personal information to another person or agency (e.g. a doctor, a party,
WorkCover NSW) as required or authorised by law.
Decisions by the Commission will generally be published, including on the Internet, unless there are
exceptional circumstances justifying the decision being withheld.
A person has a right to access their personal information and correct any inaccuracies.
Form 2C - March 2014
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