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Signature of claimant personal representative or claimant s counsel. Please print the name and relationship to the claimant of the signatory above. Check only the most serious Level Scheduled Disease VIII Mesothelioma Lung Cancer I VI V Other Cancer IV Severe Asbestosis ILO of 2/1 or greater or asbestosis determined by pathology plus a TLC less than 65 or b FVC less than 65 plus FEVl/FVC ratio greater than 65 Asbestosis/Pleural Disease Bilateral Asbestos-Related Non-Malignant Disease plus a...
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Babcock & Wilcox Company is a company specializing in energy and environmental technologies.
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