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Wcc.sc.gov Carrier File Carrier Code Employer FEIN Claimant s Name Employer s Name Address City State Home Phone - Work Phone Zip Carrier Preparer s Phone Preparer s Name This form is only applicable to injuries by accident occurring on or after July 1 2007 pursuant to Title 42-15-60 A as amended. The execution of this document is an agreement between the parties relating to a Workers Compensation claim under 42-1-160 42-1-172 or 42-11-10. Claimant s Signature Date Agreement Signed...
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Columbia, South Carolina 29202-1715 is a zip code in the city of Columbia, South Carolina.
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2007 South_Carolina wcc claimant 16a 14b preparer compensable preparers fein claimants disfigurement worsening impairment jurisdictional applicable additionally sc amended gov herein pursuant repetitive occurring verification employers arises relating phy

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