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Report on the employer's determination of a claim for a work-related death


This form should be completed when you receive a claim for dependants of a deceased employee under the Seafarers Rehabilitation and Compensation Act 1992 (Seafarers Act).

Available formats

If you would like to request this publication in a different format to what is available for download (above), or the publication is not currently available for download, please refer to:

Last updated: 12 Mar 2014