Fillable dwc3 form

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5 at http //www. tdi. texas. gov/wc/rules/ DWC FORM-003 Rev. 10/05 Page 1 WAGE INFORMATION INSTRUCTIONS employer may provide wages for the 3 months preceding the date of injury. Send to workers compensation carrier CLAIM CARRIER S CLAIM Name and fax number of carrier Initial Amended EMPLOYER S WAGE STATEMENT DWC Form-003 The Texas Workers Compensation Act and Workers Compensation rules require an employer to...
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