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Office of Talent 440 N. Broad Street, Suite 202 Philadelphia, PA 19130 Employee Benefits 440 N. Broad Street, Suite G10 Philadelphia, PA 19130 Telephone: 2154004630| Fax: 2154004631 benefits@philasd.orgWage
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How to fill out wage continuation cancellation form

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How to fill out wage continuation cancellation form

01
Obtain the wage continuation cancellation form from the appropriate party.
02
Fill out your personal information including name, address, and contact details.
03
Provide details about your employment such as employer name, position, and employment dates.
04
Indicate the reason for canceling the wage continuation benefit.
05
Sign and date the form before submitting it to the designated party.

Who needs wage continuation cancellation form?

01
Employees who are currently receiving wage continuation benefits and wish to cancel them.
02
Employers who are responsible for managing their employees' wage continuation benefits.
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Wage continuation cancellation form is a document used to notify the authorities that an employee's wage continuation benefits have been discontinued.
Employers are required to file the wage continuation cancellation form when an employee's wage continuation benefits are terminated.
The wage continuation cancellation form can be filled out by providing details about the employee, the termination date of the benefits, and any other relevant information.
The purpose of the wage continuation cancellation form is to officially cancel an employee's wage continuation benefits.
The wage continuation cancellation form must include the employee's name, employee ID, termination date of benefits, reason for cancellation, and employer's signature.
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