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Account Claimant Name: ____________________________________________ Settlement Date: ______________ Diagnosis: ______________________________________ Date of Injury: ______________ .

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Stick to these simple instructions to get WCMSA Account Transaction Record ready for submitting:

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  2. Open the template in the online editing tool.
  3. Look through the instructions to discover which information you need to give.
  4. Click the fillable fields and include the requested details.
  5. Add the relevant date and insert your electronic autograph when you fill out all other boxes.
  6. Examine the form for misprints along with other mistakes. In case there?s a need to change some information, the online editor as well as its wide variety of tools are at your disposal.
  7. Save the new form to your device by clicking Done.
  8. Send the electronic form to the intended recipient.

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