FORM AA
[See rule 6 (1)]

DEPOSIT OF COMPENSATION FOR NON-RATAL ACCIDENT TO A WOMAN OR PERSON LJNDER LEGAL DISABILITY
(Section 8 (1) of the Workmen’s Compensation Act, 1923)

Compensation amounting to Rs………..is hereby presented      for deposit in respect of injuries sustained by…. residing at…….. on……19……resulting in the loss of/temporary disablement. His/Her monthly wages are estimated at Rs………………..He/She was over/under the age of 15 years at the time of the accident.
2. The said injured workman has prior to the date of the deposit received the following half monthly payments, namely:
Rs ………….. on ……….. ..Rs ……………..on
Rs ………….. on ……….. ..Rs ……………..on
Rs ………….. on ……………Rs ……………on
Dated………………….19
Sum deposited Rs ……. …….. ……. ……. ……. ……. …….
……. …….. …….. …….
Commissioner