wage statement template
Wage Statement
Instructions. Properly filled out, this optional form will satisfy the requirements of sections 201 (d), (e), and (g) and sections 301 (c), (d),
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Creating a Supporting Statement Part A
The Supporting Statement should be prepared in the format described below, and should contain of information, identifying and using appropriate wage rate
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WAGE STATEMENT
Complete the form as fully as possible and submit it to your claims-handling entity within 14 days after knowledge of any accident that has caused your employee
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