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IC Form MSC4 rev. 4/11 NORTH CAROLINA INDUSTRIAL COMMISSION N.C. Industrial Commission Mediation Section I. C. File No s. Carrier No* County 4342 Mail Service Center Raleigh NC 27699-4342 Plaintiff v* DESIGNATION OF MEDIATOR Defendant Carrier Appearances Plaintiff sAttorneyTelephone AddressFax Defendant s AttorneyTelephone THIS FORM IS TO BE COMPLETED BY EITHER THE PLAINTIFF OR THE DEFENDANT WITHIN THE TIME SPECIFIED IN THE COMMISSION S ORDERS AND THE ICMSC RULES* Pursuant to the Order...
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How to fill out NC IC Form MSC4
01
Obtain the NC IC Form MSC4 from the official website or local government office.
02
Read the instructions carefully to understand the requirements.
03
Fill in your personal details, including name, address, and contact information.
04
Provide the necessary identification information, such as driver's license number or social security number.
05
Complete the sections related to your qualification and experience.
06
Attach any required supporting documents as specified in the form's instructions.
07
Review the completed form for accuracy and completeness.
08
Submit the form either online or via mail, as per the instructions provided.
Who needs NC IC Form MSC4?
01
Individuals applying for a specific identification card in North Carolina.
02
Residents seeking benefits that require identification verification.
03
Business owners needing to register or verify identity for licensing purposes.
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What is NC IC Form MSC4?
NC IC Form MSC4 is a legal form used to report information related to specific interactions with the North Carolina Industrial Commission.
Who is required to file NC IC Form MSC4?
Employers, insurance carriers, and third-party administrators involved in workers' compensation claims in North Carolina are required to file NC IC Form MSC4.
How to fill out NC IC Form MSC4?
To fill out NC IC Form MSC4, individuals need to provide details such as the claimant's information, the nature of the claim, and any relevant dates or descriptions pertinent to the case.
What is the purpose of NC IC Form MSC4?
The purpose of NC IC Form MSC4 is to provide the North Carolina Industrial Commission with necessary data regarding workers' compensation claims, ensuring compliance with state regulations.
What information must be reported on NC IC Form MSC4?
On NC IC Form MSC4, individuals must report information such as the claimant's name, claim number, date of injury, the type of benefits claimed, and any other necessary documentation or details related to the injury.
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