WCC Form H31R "Claimant Request for Change of Address" - Maryland

What Is WCC Form H31R?

This is a legal form that was released by the Maryland Workers' Compensation Commission - a government authority operating within Maryland. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2016;
  • The latest edition provided by the Maryland Workers' Compensation Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of WCC Form H31R by clicking the link below or browse more documents and templates provided by the Maryland Workers' Compensation Commission.

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Download WCC Form H31R "Claimant Request for Change of Address" - Maryland

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WORKERS' COMPENSATION COMMISSION
CLAIMANT REQUEST FOR CHANGE OF ADDRESS
This form can be used only to change the Claimant Address for the Claim Number indicated
and cannot be used for other parties in the claim. No filing accepted by email or FAX.
WCC CLAIM NUMBER:
CLAIMANT:
EMPLOYER:
INSURER:
NEW ADDRESS
Street
City
State
Zip Code
PRIOR ADDRESS
Street
City
State
Zip Code
CLAIMANT
CLAIMANT’S ATTORNEY
REQUESTED BY:
Street Address
FULL NAME
City
State
Zip Code
I hereby certify that on the
day of
,
a copy of this Request has been sent to
the Workers' Compensaton Commission, all parties and their attorneys.
__________________________________
Telephone Number
Date
Signature
CLICK HERE TO CLEAR THE FORM
10 East Baltimore Street Baltimore, Maryland 21202-1641
WCC H31R (01/2016)
410-864-5100 Email: info@wcc.state.md.us Web: http://www.wcc.state.md.us
WORKERS' COMPENSATION COMMISSION
CLAIMANT REQUEST FOR CHANGE OF ADDRESS
This form can be used only to change the Claimant Address for the Claim Number indicated
and cannot be used for other parties in the claim. No filing accepted by email or FAX.
WCC CLAIM NUMBER:
CLAIMANT:
EMPLOYER:
INSURER:
NEW ADDRESS
Street
City
State
Zip Code
PRIOR ADDRESS
Street
City
State
Zip Code
CLAIMANT
CLAIMANT’S ATTORNEY
REQUESTED BY:
Street Address
FULL NAME
City
State
Zip Code
I hereby certify that on the
day of
,
a copy of this Request has been sent to
the Workers' Compensaton Commission, all parties and their attorneys.
__________________________________
Telephone Number
Date
Signature
CLICK HERE TO CLEAR THE FORM
10 East Baltimore Street Baltimore, Maryland 21202-1641
WCC H31R (01/2016)
410-864-5100 Email: info@wcc.state.md.us Web: http://www.wcc.state.md.us