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Application for Scheduled Benefits CLAIM FORM B MAIB Maib Tas Gov 2012
On 13 14 50. Nominated Account Details Note Deposits will be made to your primary account only. Surname of Claimant Street Address Name of Bank Building Society or Credit Union into which funds are to be deposited. Branch where account is held Branch/BSB Number 6 Digits not account number Account Number Account held in the name s of EFT payment remittance to be sent to. Expected period of disability eg. 5 days 3 weeks 2 months Have you returned to work If yes date returned STOP IF YOU WERE A...
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