for Compromise between the Employer and Workman for Payment of Compensation
Under Workmen's Compensation Act
AGREEMENT is made at __________ on this ______ day of ___________, 2000,
between A B Co. Ltd., a company incorporated under the Companies Act, 1956 and
having its registered office at ________________ hereinafter called "the
Employer" (which expression shall unless repugnant to the context or
meaning thereof include its successors and assigns) of the ONE PART and Mr. X S/o
_________,R/o _______________ hereinafter called "the workman" (which
expression shall unless repugnant to the context or meaning thereof, include
his heirs, executors, administrators and assigns) of the OTHER PART.
the workman was employed by the employer in its factory in the capacity of
___________ and on ________ he was injured by an accident arising out of and in
the course of his employment, in respect of which he claims that the employer
is liable to pay him compensation under the Workmen's Compensation Act.
in order to avoid litigation in respect of the said claim, the parties hereto
are desirous that the liability of the employer (if any), shall be satisfied by
the compensation herein agreed to be made.
THIS DEED WITNESSETH THAT IT IS HEREBY AGREED AS FOLLOWS:
1. The employer shall
pay the workman the sum of Rs. __________ as compensation for such injury as
aforesaid on __________.
2. The employer shall
also pay the workman the sum of Rs. _________in respect of the costs of his
medical attendance and other expenses.
workman shall accept the before mentioned payments in full discharge of all
liability of the employer to pay compensation under the Workmen's Compensation
Act or any law for the time being in force and doth hereby release the employer
from any and all liability in respect of the injury caused to the workman and
from any and all liability for any damages, which may result to the said
workman in future on account of the said injury.
WITNESS WHEREOF, the employer hereto has set its hands and seal and the workman
has set his hands hereunto and to a duplicate hereof, the day and the year
first hereinabove written.
common seal of ABC Co. Ltd. has been hereunto affixed pursuant to the
Resolution of its Board of Directors dated the _____ day of __________, 200-__,
in the presence of Shri ______________ and _________________Directors who have
signed in token thereof.
and delivered by A, the with in named workman
Name & Signature
Name & Signature