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WORKERS COMPENSATION APPLICATION AGENCY DATE (MM/DD/YYY) COMPANY APPLICANT NAME E-MAIL ADDRESS MAILING ADDRESS (including ZIP + 4) PHONE (A/C, No, Ext): FAX (A/C, No): E-MAIL ADDRESS: YRS IN BUS SIC
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What is amount oformr coverages?
Amount oformr coverages refers to the total dollar value of insurance coverage.
Who is required to file amount oformr coverages?
Employers and individuals who have insurance coverage are required to file amount oformr coverages.
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Amount oformr coverages can be filled out by providing information about the total amount of insurance coverage obtained.
What is the purpose of amount oformr coverages?
The purpose of amount oformr coverages is to report the total value of insurance coverage available.
What information must be reported on amount oformr coverages?
The information reported on amount oformr coverages includes the total dollar value of insurance coverage.
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