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Get and Sign Wcb Form 3 British Columbia 2017-2022
Care number
WorkSafeBC claim number
Worker information
Worker last name
First name
Address line 1
Preferred first name
Address line 2
City
Province/state
Home phone number (please include area code)
Country (if not Canada)
Postal code/zip
Business phone (please include area code)
Business ext.
Date of birth (yyyy-mm-dd)
-
Middle initial
E-mail address
Personal health number (BC CareCard)
Social insurance number
-
Worker’s occupation
Weight
Height
Gender
Marital...
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