Form V

[See sub-rule(6) of rule45]

Before the Employees' Insurance Court, at…………………….

Summons for Settlement of issues

To,

..................

(Name, description and address)

Whereas ……………. has instituted proceedings against you for ……….. You are hereby

summoned to appear in this Court in person or by authorized agent duly instructed and able to answer all

material questions relating to the case or who shall be accompanied by some person able to answer all such

questions at ……… o’clock in the …… noon on the ……. day of........ 20, to answer the.

Claim and the date fixed for appearance is appointed for the final disposal of the proceedings you must be

prepared to produce on that day all the witnesses, upon whose evidence, and all the documents upon which

you intend to rely in support of your defence.

Take notice, that in default of your appearance on the above mentioned, the case will be heard and

decided in your absence.

Given under my hand and the seal of the Court, on this……….day of.................... 20….

COURT

Notice:

1. If you are apprehend that you will witness will not attend of their own accord, you can have a summons from

this Court to compel the attendance of any witness to produce, on applying to the Court and on depositing the

necessary expenses.

2. If you admit the claim you should pay the money into Court together with the cost of the proceedings to

avoid execution of the decree which may be passed against you in person or property or both.