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Format of Authority Letter for Workmen Compensation

Birth Certificate Affidavit FormatBEFORE THE _________ WORKMENS’ COMPENSATION COURT, _________



Application under the Workmen’s compensation Act For the grant of compensation of _________ /-

Authority Letter


I, the undersigned do hereby authorize _________, as my Authorised Representatives to conduct the above mentioned case on behalf of me. All the agreements and commitments done by my above said A.R. shall be ratified and confirmed by me.


Dated:Accepted  by:

_________, resident of _________,
_________, ________

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