Industrial Accident Board, or Arbitration Committee, as case may be. on the above-entitled claim, have been determined by said Committee, or Board, to have been______. --by you without reasonable § 323. Form of receipt on account of compensation. (n) Received of--- Name of insurance association or company. the sum of-----------dollars, and----- ----cents, being the proportion of my weekly wages for the period from the----------day of‒‒‒‒‒‒‒‒, 191---, to the‒‒‒‒‒‒‒‒ day of‒‒‒‒‒‒‒‒‒‒, 191---, under the Massachusetts Workmen's Compensation Act, subject to review by the Industrial Accident Board.8 § 324. Form of settlement receipt. (o)" Received of----- Name of insured. -----dollars the sum of‒‒‒‒‒‒ and‒‒‒‒‒‒‒‒‒‒cents, making in all, with weekly payments already received by me, the total sum of---------dollars and______ ----cents, in settlement of compensation under the Massachusetts Workmen's Compensation Act, for all injuries re 8 Every agreement in regard to compensation is subject to approval by the Industrial Accident Board, and a memorandum of the same must be filed with the Board, whether said agreement is written or oral, and whether it is made by one or both parties, or in the form of a receipt. Any weekly payment or settlement under the act, whether purporting to be final or otherwise, may be reviewed by the Board. Section 20, Part II, and sections 4 and 12, Part III, chapter 751 of the Acts of 1911, and amendments thereto, and rule adopted by the Board. 9 Every agreement in regard to compensation under this act is subject to approval by the Industrial Accident Board, and a memo ceived by me on or about the.... đay of 191 while in the employ of---- Name of employer, city or town, street and number. subject to approval and review by the Industrial Accident Board. Witness my hand this------------day of‒‒‒‒‒‒‒‒‒ Witness 191... randum of the same must be filed with the Board, whether sid agreement is written or oral, and whether it is made by one or both parties, or in the form of a receipt. Any weekly payment or settle ment under the act, whether purporting to be final or otherwise. may be reviewed by the Board. (Section 20, Part II, and sections 4 and 12, Part III, chapter 751 of the Acts of 1911, and amendments thereto, and Rule No. 6 adopted by the board.) |