Missouri wc 21 fillable form 2014-2026

1. Click ‘Get Form’ to open the Missouri wc 21 fillable form in the editor.
2. Begin by filling out the Employee Information section. Enter the injured employee’s name, mailing address, and social security number in the designated fields.
3. In Box 4, provide the date of accident or occupational disease. Ensure you follow the guidelines for repetitive motion claims as outlined in the instructions.
4. Complete Box 5 with the average weekly wage earned by the employee. This should reflect gross wages, not net.
5. Fill out Box 7 with the ZIP code where the accident occurred, ensuring accuracy for processing.
6. If applicable, complete Box 15 with dependent information only if the employee has died. Make sure to include all necessary details.
7. Finally, sign Box 16 as the injured employee or claimant unless represented by an attorney. Review all entries for legibility before submitting.

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