Get the db 125 form

Description of DB-125
If you become sick or disabled AFTER the first four 4 weeks of unemployment file your claim with the Workers Compensation Board on Form DB-300. For additional information on Disability Benefits call or write the WORKERS COMPENSATION BOARD Office at 100 Broadway Menands ALBANY NY 12241-0005 800 353-3092 DB-125 2-05 Reverse www. DISABILITY BENEFITS HAVE BEEN PROVIDED BY Name Address EMPLOYER U. I. NUMBER BY INSURING...
Fill & Sign Online, Print, Email, Fax, or Download
Fill Online
  • Fill Online
  • eSign
  • Fax
  • Email
  • Add Annotation
  • Share
db 125 form
Rate This Form DB-300 form