CaliforniaCourt forms

Stipulations with request for award

Form DWC-CA 10214-a. Official DWC file, and — where this filing is what the panel ruled on — the passage it turned on.

Form: DWC-CA 10214-a
Category: Court forms
Languages: English

What this form is for

Stipulations with request for award * For injury on or after 1-1-2013

Official file

Published by the Division of Workers' Compensation. This page does not replace the form — it points at the state's PDF and, where the form is what a panel actually ruled on, quotes that ruling.

Download PDF →English PDF

How to fill a DWC form →

Source: dir.ca.gov/dwc/forms.html. Unofficial guide — the PDF on that site is the form.

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