Claim Forms

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Claim Forms

Employer's Report of Incident

Employer’s Report of Incident

(Employer Must Complete)

Employee's Report of Incident

Employee’s Report of Incident

(Employee must complete, but Employer may transcribe)

Policy Numbers

Business Insurers of Georgia SUNZ – WC014-00001-020

InSource United Wisconsin Insurance Company (UWIC) – WC526-00001-020-SZ

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