(2) 1[ An application to a Commissioner] may be made in such form and shall be accompanied by such fee, if any, as may be prescribed, and shall contain, in addition to any particulars which may be prescribed, the following particulars, namely:--
(a) a concise statement of the circumstances in which the application is made and the relief or order which the applicant claims;
(b) in the case of a claim for compensation against an employer, the date of service of notice of the accident on the employer and, if such notice has not been served or has not been served in due time, the reason for such omission;
(c) the names and addresses of the parties; and
(d) 2[ except in the case of an application by dependants for compensation] a concise statement of the matters on which agreement has and 3[ of] those on which agreement has not been come to.