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Workers' Compensation Board (WCB)

Board Review Settlement/Withdrawal Notification

To notify the Board that a case has settled or withdrawn, please provide the following information:

WCB Case Number(s):*
Claimant's Name:*
Name of Submitter:*
Phone Number:*	( )
Your E-Mail Address:*
*Required

	Settlement*	Withdrawal*
*NOTE: Written confirmation is required, with copy to opposing party/attorney.

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