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- Click ‘Get Form’ to open the form C-4 in the editor.
- Begin by entering your personal information in the 'Employee’s Claim' section. Fill in your first name, middle initial, last name, birthdate, home address, age, and contact details.
- Next, provide your employment details including your occupation at the time of injury and your employer's name. Ensure you include the claim number if applicable.
- In the 'Details of Injury' section, describe what you were doing at the time of the accident and how it occurred. Be specific and utilize additional sheets if necessary.
- Complete the certification statement at the end of the form by signing and dating it to confirm that all information is accurate.
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