N.J. Admin. Code § 12:235-6.2

Current through Register Vol. 56, No. 11, June 3, 2024

Section 12:235-6.2 - Application form for commutation

(a) The application for commutation shall be made on a form prescribed by the Division which shall include:

1. The applicant's name, address, and social security number;

2. The name and address of the employer;

3. The name, address, and file number of the employer's insurance carrier;

4. The date of award;

5. The Judge of Compensation and the place wherein the award was rendered;

6. The amount of the award;

7. The amount of balance due on the award;

8. The amount requested for commutation; applicant's marital, employment, and economic status;

9. The purpose(s) for which commutation is being requested; and

10. Such other information as prescribed by the Director.

(b) The application for commutation shall be under oath or affirmation of the applicant.

(c) The application for commutation shall include, or have attached thereto, all documents upon which the applicant is relying in the application.

N.J. Admin. Code § 12:235-6.2

Amended by R.1991 d.466, effective 9/3/1991.
See: 23 New Jersey Register 1759(a), 23 New Jersey Register 2642(a).
Stylistic changes.
Amended by R.1997 d.110, effective 3/3/1997.
See: 28 New Jersey Register 4067(a), 29 New Jersey Register 799(a).
Inserted new (a)9 and recodified former (a)9 as (a)10.