| Ready for Verification | Case Member | Case Reference | Evidence Type | Verifiable Data Item | Submitted Document(s) |
|---|---|---|---|---|---|
| [True] | [A. Name] | [Case Reference No.] | [Sickness Benefit Evidence] | [A. Name] | [Attachment Name] |
Evidence for Verification
| Ready for Verification | Case Member | Case Reference | Evidence Type | Verifiable Data Item | Submitted Document(s) |
|---|---|---|---|---|---|
| [True] | [A. Name] | [Case Reference No.] | [Sickness Benefit Evidence] | [A. Name] | [Attachment Name] |