AFFIDAVIT OF EMPLOYEE IN APPLICATION FOR TRUST FUND BENEFITS Forms
| Form Name | AFFIDAVIT OF EMPLOYEE IN APPLICATION FOR TRUST FUND BENEFITS |
| Form # | Form 170 |
| Form Revision | 7/2019 |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Massachusetts |
| Language | English |
| State Description | This form is to be filled out only if the injured worker is filing a claim against the Workers' Compensation Trust Fund. Forward the completed form to: Workers' Compensation Trust Fund, Depa |
| Claimwire Description | n/a |