The DB-155 must be completed by the Board’s Self-Insurance Office. Система защиты от роботов предположила,что вместо вас действует программа. This form is not filed. It must be completed by the insurance carrier or self-insured political subdivision with identifying insurance information and then displayed in the firehouse and fire company headquarters. Подавать не позднее чем через 30 дней после возникновения заболевания или получения инвалидности.Обратите внимание!
The C-105.2 must be completed by the insurance carrier or its licensed insurance agent. Бланк формы (скачать его можно на нашем сайте) и указания по его заполнению утверждены постановлением Госкомстата РФ от 21.01.2003 № 7. Скачать унифицированную форму ОС-4 Напомним, что в настоящее время использование унифицированных форм необязательно. Filed with any entity requesting to be a certificate holder including a government agency issuing a permit, license or contract. The DB-120.1 must be completed by either the NYS statutory disability benefits insurance carrier, or a licensed NYS insurance agent of that carrier. Upon securing of workers’ compensation insurance or Board-approved self-insurance. Please read all information and instructions on the front of the form. DD-2 (9/05) Biannual Recertification to Entitlement to Benefits A claimant who is having benefit checks directly deposited in a financial institution.
The DB-120.2 must be completed by the Plan Administrator or Authorized Representative. Employers must obtain this form from the State Insurance Fund. VAW-1 (8/97) Notice to Liable Political Subdivision of Volunteer Ambulance Worker’s Injury or Death Volunteer Ambulance Worker Send to political subdivision liable for benefits. [This is not a claim for benefits. This form is not filed. It must be completed by the insurance carrier or self-insured political subdivision or unaffiliated ambulance service with identifying insurance information and then displayed in the ambulance company headquarters. Employers must obtain this form from their insurance carrier or licensed agent. Employers must obtain this form from their administrator.