Home Page Contents      Legal Summaries Contents      Forms    

VIRGINIA:

                  IN THE COURT OF APPEALS OF VIRGINIA

 (Claimant’s Name),

                                           Appellant

against Record No.

                                                                                    (VWC File No.                      )

(Employer and Insurer’s Names),

                                            Appellees.

MOTION TO WAIVE APPEAL BOND

            Appellant, by counsel, pursuant to the provisions of Section 8.01-676.1 of the Code of Virginia, moves to proceed with his appeal to the Court of Appeals without the necessity of filing a bond for the following reasons:

1.                  As reflected in an Affidavit attached to this Motion as Exhibit A and made a part hereof, since leaving the employ of the Appellee                                in              19    , following his (accident/ development of an occupational disease), Appellant has not returned to his employment with the exception of                                             , (and/or) is disabled. The nature of his disability is and by reason of his disability is unemployed, is incapable of his employment by reason of  his disability, and remains unemployed at this time. Appellant’s income comes from                                                  of $           per week and income from                                                                                                 .  (Note: Section 8.01-676.1 provides in pertinent part, "K1. Virginia Workers' Compensation Commission. - No claimant who files an appeal from a final decision of the Virginia Workers' Compensation Commission with the Court of Appeals shall be required to post security for costs as provided in subsection A or B of this section if such claimant has not returned to his employment or by reason of his disability is unemployed. Such claimant shall file an affidavit describing his disability and employment status with the Court of Appeals together with a motion to waive the filing of the security under subsection A or B of this section.")

2.                  That because of his loss of income and employment he has not been able and currently is not able to pay his bills.

3.                  (If Applicable) That he is indigent and financially unable to post the bond under Va. Code Sec. 8.01-676.1.

       WHEREFORE, for the reasons stated above, Appellant moves that he be permitted to proceed with his appeal without the necessity of filing a bond.

                                                             Respectfully submitted,

                                                              (Claimant’s Name)

                                                             By________________________________

                                                                                         Counsel

Name, Address and

Telephone No.

Of Counsel

CERTIFICATE OF SERVICE

           I hereby certify that on this     day of                       , 19    , a true copy of the foregoing Motion to Waive Bond and accompanying Affidavit were mailed to

                                                                                                                 , counsel for Appellees.

                                                                             _______________________________

                                                                                                (Counsel’s name)       

   Home Page Contents      Legal Summaries Contents      Forms