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Get D-8 - Form - Employer's Wage Verification Form

The amount of disability compensation to which your employee is entitled may be calculated. Prompt completion and return of this form will ensure the timely payment of any compensation due this injured worker. Please answer all questions and sign the form where indicated. EMPLOYER: PLEASE PROVIDE THE FOLLOWING INFORMATION ANSWERING ALL QUESTIONS Date: Injured Employee's Name (Last/First/M.I.): Claim No.: D.P.T. No.: Social Security # Date of Injury: Date of Hire: Was employee hired to wo.

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