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Get Canada WCB Alberta C921 2020-2024

City/Town Date of Birth (yyyy/mm/dd) Date of Accident (yyyy/mm/dd) Province Telephone Number Postal Code Claim Owner s Name Telephone Number Provider s Name Telephone Number Date Report Faxed to WCB (yyyy/mm/dd) Time Report Faxed to WCB Provider Reference Number Description of Incident (include dates and times): Has there been a similar incident(s) in the past? Yes No If yes, how did you attempt to resolve it (them)? What were the results of past resolution attempt(s)? W.

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