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Get Canada WSIB 1824A 2022-2024

Tion Name Worker Employer/Company name Address City/Town Employer Telephone Fax Language Postal code English French Other (please specify) Part B - Representative information * Name of person and/or organization to be authorized Address City/Town Telephone Fax Postal code Signature Please complete one of the following three (1, 2 or 3) as applicable: 1. My Law Society of Upper Canada or Application ID No. 2. I am / My organization is exempt from the paralegal licensing requireme.

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