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Report of Minor Injuries Submit to: Virginia Workers' Compensation Commission 1000 DMV Drive Richmond VA 23220 45 A See instructions on the reverse of this form. Insurer Name of insurer or self-insurer

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Form VWC No 3 is a form that needs to be filled out and submitted for a specific purpose.

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The purpose of form VWC No 3 is to gather specific data or information for compliance or reporting purposes.

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