IN THE DISTRICT COURT OF THE
HONG KONG SPECIAL ADMINISTRATIVE REGION
PERSONAL INJURIES ACTION NO. OF ______
TAKE NOTICE that the abovenamed Plaintiff has on __________ commenced this action in the District Court against the Defendant for damages for personal injuries caused to the Plaintiff by reason of negligence and/or 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 Defendant and/or its employees and/or servants and/or agents in an accident which took place on __________ at __________. The Defendant was the employer of the Plaintiff at the material time.
TAKE FURTHER NOTICE that at the time of the work accident, the said Defendant was 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. __________)
IN THE DISTRICT COURT OF THE
HONG KONG SPECIAL ADMINISTRATIVE REGION
PERSONAL INJURIES ACTION NO. OF ______
NOTICE TO INSURER
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Filed on this __________ day of __________.
Plaintiff acting in person
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