Form 19W153 PDF Details

In the realm of workers' compensation, ensuring timely and accurate payments to claimants is crucial. Occasionally, issues such as checks not being received, or being lost, destroyed, or stolen, necessitate swift action. The 19W153 form, specifically designed for such situations, offers a structured way for individuals with corporate accounts to request a stop payment on a cheque issued by WorkSafeBC. This form captures essential information, including worker and payee details, address, and the specifics of the payment in question, such as cheque number, amount, and the dates it was issued. Individuals must also specify the reason for the stop payment request, choosing from options like not received, destroyed, lost, or stolen. By completing this form, claimants affirm their understanding that the cheque in question will be voided, and if it does eventually arrive, it needs to be returned to WorkSafeBC. This process is overseen by WorkSafeBC's Corporate Accounting department, ensuring that claimants' compensation is managed securely and efficiently. Moreover, the form serves as a reminder of the importance of protecting personal information, adhering to the Workers Compensation Act and the Freedom of Information and Protection of Privacy Act, hence offering reassurances regarding privacy and data protection.

QuestionAnswer
Form NameForm 19W153
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesworksafe, wsbc login, bc worksafe login, worksafebc login

Form Preview Example

STOP PAYMENT REQUEST

CORPORATE ACCOUNTING

MAIL

FAX

Phone 604 231-8506, press “1”

Corporate Accounting, WorkSafeBC

604 279-7515

Toll-free 1 888 967-5377, ext. 8506, press “1”

PO Box 5350 Stn Terminal

 

 

Vancouver BC V6B 5L5

 

Worker information

Worker last name

First name

Middle initial WorkSafeBC claim number

Payee information

Payee last name

First name

Middle initial Payee number

Address information

Address line 1

City

Province

Postal code

Address line 2

Phone number (include area code)

Payment stop information

Cheque number

Amount ($)

Cheque printed date

From date

To date

(yyyy-mm-dd)

(yyyy-mm-dd)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The above-noted cheque(s) were

 

 

 

 

Not received by me

Destroyed

 

 

 

Lost

Stolen

 

I understand that this cheque cannot be cashed as a result of this STOP PAYMENT request. Should I receive the original cheque, I will return it to WorkSafeBC.

Claimant/payee signature

Notes

Personal information on this form is collected for the purposes of administering a worker’s compensation claim by WorkSafeBC in accordance with the Workers Compensation Act and the Freedom of Information and Protection of Privacy Act. For further information about the collection of personal information, please contact WorkSafeBC’s Freedom of Information Coordinator at PO Box 2310 Stn Terminal, Vancouver BC, V6B 3W5, or telephone 604 279-8171.

19W153

Workers’ Compensation Board of B.C.

(R01/12) Page 1 of 1

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