Meadowbrook Insurance Group Fillable Forms
THE USE OF THIS FORM IS REQUIRED UNDER THE PROVISIONS OF THE ALABAMA WORKERS'S COMPENSATION LAW WCC Form 2 Rev. 9/2006 STATE OF ALABAMA EMPLOYER'S FIRST REPORT OF INJURY OR OCCUPATIONAL DISEASE Ombudsman 1-800-528-5166 CLAIM REFERENCE 1. Insured Report Number 2. Filing Office Claim Number 3. OSHA Log Case Number EMPLOYER 4. Employer Business Name 5. Physical Address 1 6. Physical Address 2 7. City 15. Federal ID Number ADDRESS, IF LOCATION DIFFERENT FROM BUSINESS ADDRESS 10. Mailing Address 1 11 MoreEMPLOYER. 4. Employer Business Name. 5. Physical Address 1 Less
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