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Directory Results for Mail To: Worcester Chapter 74 AFE Attn: Scholarship Committee P O Box 3431 Worcester, MA 01613 Please Contact the Scholarship Committee via Phone as well To in them that this application is being sent via USPS - afe74 to MAIL TO: WORKERS ' COMPENSATION INSURER Employee Social Security Number Employer UI Account Number EMPLOYER REPORT Employer Federal ID Number OF INJURY/ILLNESS This report is completed by the Employer for each injury/illness identified by them or the

Mail To: Worcester Chapter 74 AFE Attn: Scholarship Committee P O Box 3431 Worcester, MA 01613 Please Contact the Scholarship Committee via Phone as well To in them that this application is being sent via USPS - afe74
MAIL TO: WORKERS ' COMPENSATION INSURER Employee Social Security Number Employer UI Account Number EMPLOYER REPORT Employer Federal ID Number OF INJURY/ILLNESS This report is completed by the Employer for each injury/illness identified by them or the