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Created July 8, 2017 03:25
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Worker compensation wage statement




File: Download Worker compensation wage statement



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WC-6 WAGE STATEMENT. GEORGIA STATE BOARD OF WORKERS' COMPENSATION. IF YOU HAVE QUESTIONS PLEASE CONTACT THE STATE BOARD WAGE STATEMENT. STATE OF MAINE. WORKERS' COMPENSATION BOARD. 27 STATE HOUSE STATION, AUGUSTA, MAINE 04333-0027. 1. INSURER WORKERS' COMPENSATION COMMISSION. STATEMENT OF WAGE INFORMATION. WCC Form C-2 (10/2016). 10 East Baltimore Street Baltimore, Maryland The purpose of the form is to provide the employee's wage information to the carrier for calculating the employee's Average Weekly Wage (AWW) to establish benefits due to the employee or a beneficiary. "Wages" include all forms of remuneration payable to an employee for personal services, including fringe benefits. Wage Statement. This form enables us to calculate the correct compensation that may be due to an injured employee. Please complete the form and submit to 1 Jan 2001 Employee Name: Carrier Claim No. INSTRUCTIONS FOR. COMPLETING WAGE STATEMENT. (To be completed only if claimant receives less EMPLOYER'S STATEMENT OF WAGE EARNINGS (Preceding the Date of Did the injured worker's compensation include board, rent, housing, tips and/or If the injured employee worked during “substantially the whole of 13 calendar weeks” immediately preceding the accident, the employee's average weekly wage is one-thirteenth of the total amount of wages earned during the 13 calendar weeks. NOTICE TO EMPLOYER: Please read all instructions on this form carefully. CALIFORNIA WAGE STATEMENT. California state law mandates that an employer shall provide proof of earnings for all injured workers when the injury results


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