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Get Canada C060 2018

Uired? REV NOV 2018 Yes Yes Yes No No No Complete all three pages and sign the form before sending. If your injury is the result of a motor vehicle accident, complete the Automobile Accident Report (L-054). WORKER REPORT Page 2 of 3 Worker’s last name: Worker’s first name: Social Insurance #: Injury Details Initial: (Year / Month / Day) Date of birth: What part of body was injured? (hand, eye, back, lungs, etc.) Left side Ri.

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