FORM H
[See rule 20]
APPLICATION FOR COMMUTATION
Under section 7 of the Workmen’s Compensation Act, 1923)
                       
To the Commissioner for Workmen’s Compensation, …………….…….……………… ……..……………..residing at ………………………………………..          applicant,
Versus
..........…….. …….. ……… ………………………residing at ……….............…….. ……… ………. ……… …….. …….. ……… ……Opposite party.
It is hereby submitted that -
(1) The applicant/opposite party has been in respect of half-monthly payments from ……… to………in respect of temporary disablement by accident arising out of and in the course of his employment.
(2) The applicant is desirous that the right to receive half-monthly payments should be redeemed.
(3)        (a) The opposite party is unwilling to agree to the redemption of the right to receive half-monthly payments.
(b) The parties have been unable to agree regarding the sum for which the right to receive half-monthly payments should be redeemed.
You are therefore requested to pass orders -
(a) Directing that the right to receive half-monthly payments should be redeemed,
(b) Fixing a sum for the redemption of the right to receive half-monthly payments.
Dated ……………………..19………….
...................Applicant.