Get Md Wcc Employer Designee H23r V. 6/2009. Form To Specify A Recipient For Notice Of Claim For An

The MD WCC Employer Designee H23R V. 6/2009 form allows employers to designate a recipient for notifications regarding employee claims. Properly completing this document ensures that employers remain informed about any claims filed against them.

Follow the steps to successfully complete the MD WCC Employer Designee form online.

1. Use the ‘Get Form’ button to obtain the MD WCC Employer Designee H23R form and open it in your editing interface.
2. In the 'Name of Employer' field, enter the full legal name of your organization that is listed on your registration.
3. Provide the complete 'Address' of the employer, ensuring that it matches the address associated with the employer's registration.
4. Enter the 'Telephone Number' of the employer for contact purposes.
5. In the 'Name of Designee' field, write the full name of the individual who will receive copies of employee claim notices.
6. Fill out the 'Address' of the designee, including any necessary details to ensure accurate delivery.
7. Input the 'Telephone Number' of the designated recipient for any follow-up communications.
8. In the 'Requested By' section, specify that the request is made by the employer.
9. Provide the 'Authorized Signature' of the person completing the form, ensuring that this individual has the authority to make requests on behalf of the employer.
10. Indicate the 'Title' of the person authorized to submit this request.
11. Fill in the 'Date' the form is being completed.
12. Confirm the 'Telephone Number' for the person completing the form.
13. Enter the 'Address' of the person completing the form if it differs from the employer address.
14. After reviewing all entries for accuracy, save your changes, then download, print, or share the completed form as needed.

Complete your MD WCC Employer Designee form online today to ensure timely communication regarding employee claims.