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Get Intent To Object Form

Name Claim No. start 2. Objecting Party Worker Worker Representative Employer Representative Employer Transfer-of-Cost Employer 3. General Information Is the worker/employer address and contact information the same as the decision letter? Yes No, see changes below. Name Address City/Town Telephone No.: (Day) ( ) Telephone No.: (Evening) ( Language English ) Postal Code French Other 4. Representation See Instruction Sheet for information on possible assistance availabl.

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