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@ -393,8 +393,7 @@ |
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<i class="fa fa-square-o" aria-hidden="true"></i> Claimant 1 <i class="fa fa-square-o" aria-hidden="true"></i> lawyer for Claimant 1 |
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</p> |
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<p> |
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<span class="form-entry not-complete"> </span><br /> [ |
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<em>type or print name</em>] |
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<span class="form-entry not-complete"> </span><br /> |
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</p> |
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</td> |
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</tr> |
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@ -413,8 +412,7 @@ |
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<i class="fa fa-square-o" aria-hidden="true"></i> Claimant 2 <i class="fa fa-square-o" aria-hidden="true"></i> lawyer for Claimant 2 |
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</p> |
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<p> |
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<span class="form-entry not-complete"> </span><br /> [ |
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<em>type or print name</em>] |
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<span class="form-entry not-complete"> </span><br /> |
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</p> |
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</td> |
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</tr> |
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@ -449,8 +447,7 @@ |
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Signature of lawyer |
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</p> |
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<p> |
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<span class="form-entry not-complete"> </span><br /> [ |
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<em>type or print name</em>] |
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<span class="form-entry not-complete"> </span><br /> |
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</p> |
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</td> |
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</tr> |
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@ -491,8 +488,7 @@ |
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Signature of lawyer |
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</p> |
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<p> |
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<span class="form-entry not-complete"> </span><br /> [ |
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<em>type or print name</em>] |
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<span class="form-entry not-complete"> </span><br /> |
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</p> |
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</td> |
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</tr> |
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