(Virginia Workers' Compensation Commission caption)
Petitioner | ) | |
v. | ) | No. ______ |
Respondent | ) |
The Appellant, ___________, (intending to appeal) (having appealed from) an award of the Virginia Workers' Compensation Commission rendered on ________, 2___, we ____________, as principal and ___________, as surety, bind ourselves, our heirs, successors, personal representatives and assigns, jointly and severally, to Appellee(s), ____________, in the sum of $____, to pay all damages, costs, and fees that may be awarded against (him) (her) (them) (it) in the Court of Appeals and Supreme Court, if it takes cognizance of the claim.