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Get Form 19w1

Ry of these benefits, please complete and return this form to: Claims Call Centre Fax Mail Phone 604.231.8888 604.233.9777 WorkSafeBC Toll-free 1.888.967.5377 Toll-free 1.888.922.8807 PO Box 4700 Stn Terminal M F, 8:00 a.m. to 4:30 p.m. Vancouver BC V6B 1J1 Identification section Applicant last name Applicant first name Applicant current address Middle initial City WorkSafeBC claim number Province Postal code Applicant email address Start EFT To start or change EFT Change EFT In ord.

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