Get Worksafebc Authorization Of Representative Form 63m4 If You Want Someone To Act As Your

Completing the WorkSafeBC Authorization Of Representative Form 63M4 is essential if you wish to appoint someone to act on your behalf regarding WorkSafeBC matters. This guide provides clear, step-by-step instructions to help you accurately fill out the form online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your information in the 'Information about you' section. This includes your WorkSafeBC claim number and employer account number if applicable. Indicate your title and provide your full name, mailing address, and contact numbers.
3. Specify your identification by selecting one from the list: a worker, a deceased worker’s dependant, an employer, or other. If selecting 'other,' please provide an explanation.
4. In the 'Scope of Representation' section, check all applicable matters your representative will handle. Make sure to select all relevant areas, such as compensation claims, return-to-work matters, or any specific claim numbers.
5. Designate your representative in the appropriate section. You may either fill in the name of a person or an organization. Provide their mailing address, contact numbers, and relationship to you.
6. Read and confirm your consent to allow WorkSafeBC or WCAT to disclose information to your representative. Acknowledge the replacement of any previous authorizations and understand the conditions under which the form remains effective.
7. Sign and date the form in the designated areas. Your signature is required, and you must ensure that the date is in the correct format (yyyy-mm-dd).
8. Once completed, review all your entries for accuracy. Finally, you can save changes, download, print, or share the form as necessary.

Complete your WorkSafeBC Authorization Of Representative Form 63M4 online today.