Enforcement Rules for State Compensation Law Article 17

In order to claim compensation, a written application with the signature of the claimant or the agent must be made to the liable compensating authority; the application shall include:1. The claimant's name, sex/gender, date of birth, place of birth, identification number, employment, and residence/domicile; where the claimant is a juridical person or an association, the name of the juridical person or the association, the principle office, the name, gender and residence/domicile of the representative. 2. Where there is an agent, the agent's name, sex/gender, date of birth, place of birth, identification number, employment and residence/domicile.3. The facts, reasons and evidence of the compensation claimed.4. The amount of the payment or the prior condition needed to be restored.5. The liable compensating authority.6. The dateWhere the application does not conform to the format prescribed in the preceding paragraph, the liable compensating authority shall immediately notify the claimant or the agent to amend the application within a period of time.