Get Dol-esa Forms. Ls-33 - Dol

This guide provides clear and supportive instructions on how to fill out the DOL-ESA Forms. Ls-33 - Dol. It is designed for individuals seeking to complete this form accurately and efficiently.

Follow the steps to fill out the DOL-ESA Forms. Ls-33 - Dol.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing platform.
2. In the claimant section, fill in your last name, first name, and middle initial as applicable.
3. Enter your OWCP case number in the designated field to associate the form with your claim.
4. In the field for the employer, input the name of the employer involved in your claim.
5. Write down the name of the insurance carrier covering the employer for your case.
6. State the gross amount of the compromise in the specified section, followed by the date of the compromise.
7. Also indicate the net amount of the compromise in the provided space.
8. Obtain necessary signatures by having the employer and insurance carrier representatives sign and date the form.
9. Finally, sign and date the form as the claimant in the appropriate sections.
10. Once completed, you can save any changes, download, print, or share the form as needed.

Complete your DOL-ESA Forms. Ls-33 - Dol online today.