FORM O
[See rules 49 and 50]

Take notice that registration of the agreement to pay compensation is said to have been reached between you……………. and……………. on the……………… 19
…………….has been refused for following reasons, namely :
………….. …………….. …………. …………… …………… …………….
………….. ……………. …………… …………… …………… ……………
…………. ……………. …………… ……………. …………… …………….
Dated …………………19 ……………
 ………………..
 Commissioner.