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1 available at http //www. ic.nc.gov/forms. html. 10A. 0501 within 20 days after receipt of the agreement executed by the employee the employer or agreement. North Carolina Industrial Commission IC File AGREEMENT FOR COMPENSATION FOR DISABILITY Emp. Code Carrier Code G.S. 97-82 Carrier File The Use of This Form Is Required Under the Provisions of the Workers Compensation Act Employer FEIN Employee s Name Address Employer s Address City Home Telephone XXX-XXLast 4 Digits of SSN State M F Sex...
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