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A (for each applicant of the family) Affix your photo of 35X35 mm Size Signature Box First Applicant Details: 1 Surname 2 Given Name* 3 Sex and Date of Birth* 4 6 Place of Birth with country* Father/Guardian s Name* Mother s Name* 7 Nationality* 8 Passport No. and Date of Issue* Place of Issue* (DD/MM/YYYY) 5 9 10 Occupation* 11 Visible Distinguishing Mark* 12 Present Address* 13 E-Mail ID and Phone No 14 Whether PIO Card Yes/No holder? PIO Card No & Date of Issue Valid Upt.

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This covers establishment as well as principal employer particulars with reference to wage cycle ( weekly, fortnightly,and monthly), nature of work, location of work, employee details, wage rate, overtime work particulars, gross wage, deductions, and actual wage paid.

Form 19 - This is the Report of Injury form to be completed by your employer. Form 18 - This is the Injured Worker Notice of Accident Claim form to be completed and filed with the Industrial Commission by you when you have been injured on the job.

About the Central Wage Slip Form XIX It incorporates all details regarding the contractor and the workers like name, father's name, nature of work, location, and whether the central wage slip Form XIX is prepared for a week or a month.

Form 18. This is where you begin when you have a claim. This form MUST be filled out completely and submitted to the Industrial Commission when you have been injured on the job. (Note: Please e-mail completed forms to forms@ic.nc.gov.)

Medicaid (Title XIX of the Social Security Act)​ The Medicaid program was authorized by Title XIX of the Social Security Act Amendments of 1965 (Public Law 89-97), which was signed into law by President Lyndon Johnson. Medicaid is a joint state-federal program.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232