Get Texas Dwc 047 Form

Filling out the Texas Dwc 047 Form online is a straightforward process designed for employees seeking an advance of benefits. This guide provides clear and detailed instructions to help you complete the form accurately.

Follow the steps to complete the Texas Dwc 047 Form online.

1. Click ‘Get Form’ button to access the Texas Dwc 047 Form and open it in your online editor.
2. Begin with Section I, where you will provide your personal information. Enter your name (first, middle, last), Social Security number, and mailing address, as well as your telephone number and any attorney's information, if applicable.
3. Move to Section II, which pertains to your employer at the time of your injury. Enter your employer’s name and address.
4. Proceed to Section III to fill in the insurance carrier information. Document the insurance carrier's name, address, adjuster's name, telephone number, and fax number.
5. In Section IV, specify your request for an advance by detailing the amount of advance requested and the income benefits you are currently receiving. Also, include the requested maximum reduction to pay back the advance, the type of income benefits being received, and the expected disability period from your doctor.
6. Explain your financial hardship in Section IV by describing the basis for your advance request. Attach any supporting documentation, such as copies of your bills, if necessary.
7. Finally, review Section V. Read the employee certification statement carefully, then sign and date the form to confirm your understanding and accuracy of the information provided.
8. After completing all sections of the form, make sure to save your changes. You can then choose to download, print, or share the completed form as needed.

Complete your Texas Dwc 047 Form online today for a smooth benefits request process.