Client Change of Address
Please submit any address or phone number changes
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Name: *
WCB Case Number (please provide all case numbers)
Date I Moved:
MM
/
DD
/
YYYY
New Address:
Phone Number:
E-Mail Address *
I understand that by submitting this form I am changing my address on my Workers' Compensation Claims with Troy & Eaton, LLP, the NY Workers' Compensation Board, and my insurance carrier. *
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