FORM D
[See rule 91
DEPOSIT OF COMPENSATION FOR NON-FATAL ACCIDENTS, OTHER THAN TO A WOMAN OR PERSON UNDER LEGAL DISABILITY
(Section 8 (2) of the Workmen’s Compensation Act, 1923)

Compensation amounting to Rs. ……………… is hereby presented for deposit in respect of permanent/temporary injuries sustained by…………….. residing at which occurred on …………….19 …………….
Dated……………………… 19………..
Employer