I plead that, in accordance with Part III Division 2 of the Workers` Compensation and Injury Management Act 1981, the sum of ……… is a loss of Schedule 2, point 6, of the law because it is a hearing loss. In this election, I declare that I have not received compensation for noise-related hearing loss under a Commonwealth law, a Commonwealth state or territory or a country other than Australia. During this election and after the director has registered an agreement, I recognize that a distinction is granted after registration or attribution: Note:Paragraph 93E (6a) provides that, notwithstanding Section 93E (5) and even if Section 93E(6) does not apply, if the Director informs the worker in accordance with Section 93EA (b)) (i) that this subsection applies , a choice can be made within 14 days of the director`s subsequent notification to the worker. agreement or a finding of the matter has been recorded. This applies only if the worker is required to make a choice under Section 93E (3) (b) of the Act (i.e., the worker has an agreed or determined degree of disability of as much as 16%, but less than 30%). 2. The worker has no other right to withdraw the weekly payments resulting from the harm referred to in the agreement. A memorandum of understanding is concluded between (c) if the client refuses or does not comply with a written agreement on fees or expenses, without a legal apology; or 8. The worker exonerates and exonerates the employer, forever, of all rights and claims that the worker has or, for the implementation of that agreement, the employer could or could have been opposed, by law, to the violation of the worker referred to in that agreement.

4. The worker loses any right he may have, under Part III law, to compensation for a permanent injury to a compensable injury caused by an accident, in accordance with the agreement. 3. The worker is no longer entitled to the injury mentioned in the agreement (after the date of the agreement) to the payment of charges within the meaning of the Workers` Compensation and Injury Management Act 1981 Schedule 1 9, 17, 18, 18A or 19.