Workmen's Compensation Act, 1923
22. Form of application
(1) Where an accident occurs in respect of which liability to pay compensation under this Act arises a claim for such compensation may subject to the provisions of this Act be made before the Commissioner,
(1A) Subject to the provisions of sub-section (1) no application for the settlement of any matter of Commissioner other than an application by a dependant or dependants for compensation shall be made unless and until some question has arisen between the parties in connection therewith which they have been unable to settle by agreement.
(2) An application to a Commissioner may be made in such form and shall be accompanied by such fee if any as may be prescribed and shall contain in addition to any particulars which may be prescribed the following particulars namely :-
(a) A concise statement of the circumstances in which the application is made and the relief or order which the applicant claims;
(b) in the case of a claim for compensation against an employer the date of service of notice of the accident on the employer and if such notice has not been served or has not been served in due time the reason for such omission;
(c) the names and addresses of the parties; and
(d) except in the case of an application by dependants for compensation a concise statement of the matters on which agreement has and of those on which agreement has not been come to.
(3) If the applicant is illiterate or for any other reason is unable to furnish the required information in writing the application shall if the applicant so desires be prepared under the direction of the Commissioner.