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DCPI /
IN THE DISTRICT COURT OF THE
HONG KONG SPECIAL ADMINISTRATIVE REGION
PERSONAL INJURIES ACTION NO. OF
____________________
BETWEEN
Plaintiff
and
1st Defendant
2nd Defendant
____________________
NOTICE TO INSURER
TAKE NOTICE that the abovenamed Plaintiff has on commenced this action in the District Court against the 1st and 2nd Defendants for damages for personal injuries caused to the Plaintiff by reason of negligence and/breach of statutory duties and/or breach of implied terms of the employment contract and/or breach of employer’s duty of care owed to the Plaintiff and/or breach of common duty of care under the Occupiers Liability Ordinance, Cap. 314 on the part of the 1st and/or 2nd Defendants and/or its/their employees and/or servants and/or agents in an accident which took place on at . The 1st Defendant was the employer and the 2nd Defendant was the principal contractor of the Plaintiff at the material time.
TAKE FURTHER NOTICE that at the time of the work accident, the said Defendants were insured by you under Policy No. .
A sealed copy of the Writ of Summons filed herein on is enclosed herewith for your information.
Dated the day of .
Plaintiff acting in person
To: whose registered office is situated at . (Policy No.).
DCPI /
IN THE DISTRICT COURT OF THE
HONG KONG SPECIAL ADMINISTRATIVE REGION PERSONAL INJURIES ACTION NO. OF
____________________
BETWEEN
Plaintiff
and
1st Defendant
2nd Defendant
____________________
********************
NOTICE TO INSURER
********************
Filed on this day of .
Plaintiff acting in person
