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Get Georgia State Board Of Workers Compensation Form Wc 3

NTIFYING INFORMATION Phone Number Address EMPLOYEE Employee E-mail Address City State Name Zip Code Phone Number EMPLOYER Address City State Zip Code Employer E-mail Address INSURER/ SELF-INSURER CLAIMS OFFICE Name Insurer/Self-Insurer File # Name Phone Number Address SBWC ID# (five digit no.) City State Zip Code Claims Office E-mail Address B. 0 1. This serves as notice, pursuant to O.C.G.A. !34-9-221, that the right to compensation in this claim is being controverted o.

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