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- Click ‘Get Form’ to open it in the editor.
- Begin by gathering necessary documentation to verify your lost wages. This includes pay stubs, tax returns, and any verification forms from your employer or physician.
- Fill in your CVR number, victim name, and claimant name at the top of the form. Ensure all details are accurate for processing.
- Answer the questions regarding your absence from work due to crime-related injuries. Specify the dates you were absent and calculate your total weeks absent.
- Provide details on your lost wages per week and total them up. If applicable, indicate if you missed more than one week of work and ensure your physician completes the necessary verification form.
- Disclose any other sources that partially covered your lost wages, such as disability insurance or sick pay. Include relevant documentation for these benefits.
- Finally, sign and date the form before submitting it along with all required attachments through our platform.
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