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/20 (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: / / Date of conciliation/arbitration: / / Name of Arbitrator (if known): Late documents attached to this application: (complete box below) Document Form 2C Date of Document (in chronological order) / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / Start Page March 2014 Date received (Office use only) Author Application to Admit Late Documents Filed by: - Page 1 of 3 - Service: Date served on other parties: / / 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: / / Reasons in support of application (addressing Workers Compensation Commission Rules 2011 sections 10.3, 10.4, 11.1 as appropriate): Form 2C - March 2014 - Page 2 of 3 - Signature Signature of filing party (or representative): _________________________Date: / / 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 - Page 3 of 3 -