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Employee ClaimC3State of New York Workers\' Compensation Board
Fill out this form to apply for workers\' compensation benefits because of a work injury
or work related illness. Type or print neatly.
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How to fill out your work address
How to fill out your work address
01
Start by entering the name of your company or organization.
02
Enter the street address where your workplace is located.
03
Include the city/town, state/province, and postal/zip code.
04
Add any specific building or floor information if necessary.
05
Make sure to include any additional contact information such as a phone number or email address.
Who needs your work address?
01
Your work address may be needed by your employer, colleagues, clients, or for business-related activities such as shipping packages or for tax purposes.
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What is your work address?
Your work address is the physical location where you perform your job duties.
Who is required to file your work address?
Employers and employees may be required to file their work addresses, especially for tax purposes and legal documentation.
How to fill out your work address?
To fill out your work address, provide the complete address including the street number, street name, city, state, and zip code.
What is the purpose of your work address?
The purpose of your work address is to identify the location where you are employed for legal, tax, and administrative purposes.
What information must be reported on your work address?
The work address must include the company name, location, and other relevant contact information.
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