Wc102 fillable form 2007-2026

1. Click ‘Get Form’ to open the wc102 fillable form 2007 in the editor.
2. Begin by filling in the 'Board Claim No.' and the employee's identifying information, including their last name, first name, middle initial, social security number, and date of injury.
3. In section A, provide details about the county of injury and the employee's address. Ensure all fields are accurately completed for proper identification.
4. Next, move to section B where you will request production of documents. Check the boxes next to each document you are requesting from the employer/insurer.
5. If applicable, specify any wage records needed for TPD benefits and medical records as outlined in section B.
6. Finally, complete section C by certifying that you have sent a copy of this document to all named parties. Print your name, sign, and date the form before submission.

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