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Fillable SAIF Corporation 801 Claim Form

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CLAIM NO. 400 High St. SE, Salem, OR 97312 For SAIF Customer Use Area | | Dept. Shift CC SUBJECT DATE CLASS DEFAULT DATE EMPLOYER'S ACCOUNT NO. Email: saif801@saif.com Toll-free phone: 1.800.285.8525 Toll-free FAX: 1.800.475.7785 To make a claim for a work-related injury or illness, fill out the worker portion of this form and give to your employer. If you do not intend to file a workers' compensation claim...
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