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EMPLOYERS FIRST REPORT OF INJURY OR ILLNESSForm 122(Filing this form is not an admission of liability for the claim.) Employer (Name & Address Including Zip)G E N E R A LC A R R I ER Carrier/Administrator
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Carrier name address amp refers to the information pertaining to the name and address of the carrier.
Carriers or transportation companies are required to file the carrier name address amp.
You can fill out the carrier name address amp by providing the accurate name and address information of the carrier.
The purpose of the carrier name address amp is to ensure that accurate carrier information is available for regulatory purposes.
The information that must be reported on carrier name address amp includes the carrier's name and address.
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