In order to complete Form BWC 1274, you will need to provide your name and contact information, as well as the name of your business. The form will also ask for a variety of specifics about your business, such as the company's mailing address and contact information. Be sure to have this information ready before you begin filling out the form. Once you have completed all the required fields, hit submit and wait for confirmation that your submission was successful. If you have any questions about how to fill out Form BWC 1274 or what the requirements are for your specific business type, be sure to consult our website or speak with a representative from our team. We're here to help you every step of the way!
| Question | Answer |
|---|---|
| Form Name | Form Bwc 1274 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | digit, BWC, c147, Applicant |
BWC could not process the attached document for the following reason(s):
To research our records, please provide the following information as indicated by the block(s) checked:
Missing or invalid claim number; |
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The injured worker's full name; |
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The injured worker's social security number; |
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Date of injury; |
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Employer at the time of the injury; |
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Other |
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Please provide the information checked above for the attached document and return both to the
BWC customer service ofice listed below. If you need further assistance, contact this ofice at the
number provided below.
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I certify the information I have provided is truthful and correct. |
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Applicant signature |
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Date |
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