Get the form 28b

Description of form 28b
MAIL TO FORM 28B 11/2003 PAGE 1 OF 2 NCIC - STATISTICS SECTION 4334 MAIL SERVICE CENTER RALEIGH NORTH CAROLINA 27699-4334 MAIN TELEPHONE 919 807-2500 HELPLINE 800 688-8349 FOR INDUSTRIAL COMMISSION USE ONLY Days Compensation Paid Medical IC Code IMPORTANT NOTICE TO EMPLOYEE CLAIMING ADDITIONAL WEEKLY COMPENSATION CHECKS OR LUMP SUM PAYMENT If you claim further compensation you must notify the Industrial Commission...
Fill & Sign Online, Print, Email, Fax, or Download
Fill Online
  • Fill Online
  • eSign
  • Fax
  • Email
  • Add Annotation
  • Share
form 28b
Rate This Form

4.9

Satisfied

39

 Votes