Get the free Requestor Name and Address DR AHMED KHALIFA 1415 SOUTH HWY 6 SUITE 400D SUGARLAND TX...
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Texas Department of Insurance Division of Workers' Compensation Medical Fee Dispute Resolution, MS-48 7551 Metro Center Drive, Suite 100 Austin, Texas 78744-1645 518-804-4000 telephone 512-804-4811
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How to fill out requestor name and address
How to fill out requestor name and address:
01
Begin by locating the designated section on the form or document where the requestor name and address are required.
02
Write or type your full legal name in the appropriate field. It is important to provide your accurate and current name to ensure proper identification.
03
Next, provide the complete address associated with your request. This includes the street name and number, city or town, state or province, and postal or zip code.
Who needs requestor name and address:
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Providing your requestor name and address allows the recipient to establish contact, verify identity, and ensure proper documentation of the requested action or information.
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What is requestor name and address?
The requestor name and address refers to the individual or organization that is making a formal request for information or services. It includes their name, contact information, and physical address.
Who is required to file requestor name and address?
Any individual or organization that is submitting a formal request for information or services is required to provide their requestor name and address.
How to fill out requestor name and address?
To fill out the requestor name and address, you need to provide your full name, contact information (phone number, email address), and the physical address where you can be reached.
What is the purpose of requestor name and address?
The purpose of providing requestor name and address is to ensure that the requester can be contacted for any clarifications, updates, or responses related to their request, and to maintain transparency in the request and response process.
What information must be reported on requestor name and address?
The information that must be reported on requestor name and address includes the requester's full name, phone number, email address, and physical address.
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