Online Form Submission

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Disclosure Agreement
Step
Applicant Information
Step
Transcription Service Information
Step
Signature and Consent

Request for Transcript

ATTENTION: Once you start to complete the Request for Transcript application, you will NOT be able to save the information and come back to submit it later. It will not save or be submitted until you click the SUBMIT button.

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Claim Information

Claim Number(s):

Hearing Date:

Applicant Name:

Applicant Information

Contact Phone:

Address

Street:

Apartment/Unit#:

City/Town:

Province:

Postal Code:

Email Address:

Home Phone:

Cell Phone:

Work Phone:

Fax Number:

Alternate Phone:

Optional

Personal Pronouns:

He/Him

She/Her

They/Them

Other

Name Pronunciation:

Transcription Service Information

Swann Hallberg & Associates is the approved transcription company for the Appeals Commission

Swann Hallberg & Associates
Tel: 780-448-9490
Email: swannhallberg@gmail.com

Application permission

By signing this form, you give permission to Swann Hallberg & Associates to produce and deliver a copy of the completed transcript to the Appeals Commission. You also acknowledge and agree that you are responsible for the cost of preparing the transcript and the cost of the transcripts produced, and that you will arrange payment directly with the transcription company.

Signature and Consent

By my signature, I request the transcript as above, and acknowledge I am responsible for the cost. I also consent to the collection, use and disclosure of my personal information provided in this form, and the disclosure of my personal information related to the request for the transcript, including the transcript, to the other parties with a direct interest in the appeal, the WCB, and any body with the authority to review Appeals Commission Decisions.

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Name of the Person Signing:

A representative may only sign this form if they are authorized as a representative in this appeal. You must submit a separate Notice of Representation to authorize a representative.

Documents Submitted Electronically

Our email server automatically records the date and time that you submit electronic documents. This is the time and date that we mark these documents as ‘received’.