WAGE AND SALARY VERIFICATION Date Our Policyholder Date of Accident File Number Employee s Name and Address To Whom It May Concern The above named person has applied for benefits under the No-Fault Insurance as a result of injuries in an automobile accident on the date indicated. We understand this person is your employee or former employee. To determine if benefits that may be due the applicant this law requires you to provide us with the answers to the following seven questions and to...
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