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SETTLEMENT AGREEMENT - Section 32 WCL Indemnity Only ...

Indemnity Only Settlement Agreement. C-32-I (6-20) Page 1 of 3. WCB CASE NO. CARRIER CASE NO. CARRIER CODE DATE OF ACCIDENT CLAIMANT'S NAME (Please Print) CLAIMANT'S ADDRESS (Please Print) EMPLOYER (Please Print) CARRIER (Please Print) This Agreement is prepared and submitted pursuant to Section 32 of the Workers' Compensation Law.

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