Get And Sign Nc Form 18

Number F / Sex Insurance Carrier Policy Number Carrier s Address Carrier s Telephone Number Carrier s Fax Number Work Telephone Home Telephone Telephone Number Date of Birth EMPLOYEE This form must be filed with the Industrial Commission within two years of the date of injury or occupational disease or your claim may be barred. Notice shall be given to the employer immediately after the accident or as soon as practicable and within 30 days. Employee should retain one signed copy of this notice...