Ohio > Workers Comp > Industrial Commission

Representative Employer Change Of Address EMP-2 - Ohio

Representative Employer Change Of Address Form. This is a Ohio form and can be used in Industrial Commission Workers Comp .
 Fillable pdf Last Modified 7/29/2002
Get this form for FREE as a print-only pdf

REPRESENTATIVE OR EMPLOYER CHANGE OF ADDRESS/CONTACT Check one of the options below. This is a change of contact information for a: Representative Employer Rep ID # Risk # Current Contact Information on File with the Industrial Commission Name Address City, State, Zip, Country Telephone Fax Email New Contact Information to be Changed Name Address City, State, Zip, Country Telephone Fax Email Company/Firm Name Company/Firm Name Date Change is Effective (mm/dd/yyyy) These changes are authorized by the following individual with the understanding that the new address will impact the mailing of all correspondence from the Ohio Industrial Commission. Print Name Signature Date Fax the completed form to the Ohio Industrial Commission at (614) 387-3900. If you have questions contact the IC Helpdesk at (614) 644-6595. FOR OHIO INDUSTRIAL COMMISSION USE ONLY Address Changed By Date An Equal Opportunity Employer and Service Provider Timely, impartial resolution to workers' compensation appeals American LegalNet, Inc. www.FormsWorkFlow.com IC EMP2 OIC 4001 Rev. (09/16)
Link/Embed this Document
URL
Embed


Popular Searches

  1. divorce
  2. proof of service
  3. notice of appeal
  4. summons
  5. answer
  6. affidavit of service
  7. Guardianship
  8. JUDGMENT
  9. Power of Attorney
  10. answer to complaint

Bookmark and Share