Texas form employee benefits 2026

1. Click ‘Get Form’ to open the Texas Form Employee Benefits in the editor.
2. Begin by filling out Section I, which includes your personal information. Enter your full name, last four digits of your Social Security Number, mailing address, and contact numbers.
3. Proceed to Section II to provide your employer's information at the time of injury. Fill in the employer's name and address accurately.
4. In Section III, input the insurance carrier's details including their name and address, along with the adjuster's contact information.
5. Move on to Section IV where you will request an advance. Specify the amount requested and detail your current income benefits. Attach any necessary documentation regarding financial hardship.
6. Finally, review Section V for employee certification. Ensure you understand how an advance affects future benefits before signing and dating the form.

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