Get Right Of Election Form - C169 - Workers' Compensation Board - Wcb Ab

Completing the Right Of Election Form - C169 is an essential step for individuals who have experienced an industrial accident outside of Alberta and wish to claim compensation under the Workers' Compensation Act of Alberta. This guide provides a comprehensive overview of how to fill out the form online, ensuring that users can navigate the process with ease.

Follow the steps to successfully fill out the Right Of Election Form - C169 online.

1. Press the ‘Get Form’ button to obtain the Right Of Election Form - C169 and open it in your preferred editor.
2. In the first section, enter the date of the accident in the format YYYY/MM/DD. This information is crucial for establishing the timeline of your claim.
3. Fill in your surname and first name in the designated fields to accurately identify yourself as the worker involved in the accident.
4. Provide your full address, including city or town, province, postal code, and telephone number where you can be reached for any follow-up related to your claim.
5. In the election section, write the date and location of the accident clearly. Select the option to elect to claim compensation under the Alberta Act, understanding this may waive your rights to compensation in other jurisdictions.
6. Sign the form where indicated, either as the worker or a dependent. Note that the signature of a witness is also required to validate your submission.
7. Finally, review the completed form for accuracy. You can then save your changes, download, print, or share the form as needed.

Take action now and complete your Right Of Election Form - C169 online to ensure your claim is processed promptly.