Western Australian Consolidated Regulations Western Australian Consolidated Regulations (1) The form of
notification for the purposes of the Act Schedule 1 clause 1C(1)
must be in the form of Form 29 in Appendix I.
(2) The form of
notification for the purposes of the Act Schedule 1 clause 1C(4)(a)
must be in the form of Form 30 in Appendix I.
(3) An election for
the purposes of the Act Schedule 1 clause 1C(2) or clause 1C(4)
or (6) must —
(a) be
made in writing;
(b)
specify —
(i)
the name and address of the dependant;
(ii)
the relationship (child or step‑child) of the
dependant to the deceased worker;
(iii)
the name of the deceased worker, and the address of the
deceased worker at the time of death;
(iv)
whether the dependant elects to receive an apportionment
of the notional residual entitlement or a child’s allowance under the
Act Schedule 1 clause 1A;
(v)
whether the worker died leaving any spouse or de facto
partner wholly dependent on the workers’ earnings, and whether that
spouse or de facto partner is a parent of the dependant making the election;
(vi)
that the dependant has been independently advised of the
financial consequences of the election, and the name, title, address and phone
number of the person who gave that advice; and
(vii)
the date on which the election is made;
(c) be
signed by the dependant or, in the case of an election by a person under a
legal disability, the parent or guardian of that person;
(d)
include the signature and full name and address of a witness to the signature
of the dependant or his or her parent or guardian; and
(e) be
given to the Director.
[Regulation 16A inserted in Gazette
28 Oct 2005 p. 4867‑8.]