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Injury Compensation for Federal Employees Publication
(5) Prepare a supporting statement to include exposure data, test results, copies of results of previous medical examinations and/or witness statements,
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Witness Statement Form
I, being of sound mind and body do hereby declare that the information I have provided in this report is true and correct to the best of my knowledge.
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WITNESS STATEMENT - PERSONAL INJURY REPORT
Please take the time to complete this form in detail. If you need more space for answers, write on the back or attach additional pages.
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