The Workmen's Compensation (Ironworkers' Cataract) Order (Northern Ireland) 1925
Amount of compensation paid under the Workmen's Compensation Acts in respect of each child, as settled or allotted under paragraph (8) of the First Schedule to the Workmen's Compensation Act, 1906. Give date of child's birth, if possible. If not give age at date of workman's death. Full names of children in respect of whom compensation has been awarded or agreed. Date of Birth. Age. £ s. d. Signature ........................................ Registrar. Date .......................................