Reinstatement Of Guaranty Contract {3217} | Pdf Fpdf Doc Docx | Oregon

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Reinstatement Of Guaranty Contract {3217} | Pdf Fpdf Doc Docx | Oregon

Reinstatement Of Guaranty Contract {3217}

This is a Oregon form that can be used for Proof Of Coverage - Insurer within Workers Comp.

Alternate TextLast updated: 5/11/2006

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Description

Reinstatement of Guaranty Contract Insert name of insurer and address where policy/coverage information is available: Employers legal name and mailing address: Policy no.: FEIN: BIN or WCD no.: This notice is to inform you that your workers compensation policy has been renewed, effective without a lapse in coverage. The cancellation notice, issued with a scheduled effective date of , is rescinded. This notice is being sent to the employer and to the Department of Consumer and Business Services. A copy of this notice was sent to the employer. Insurer representative signature: Date: Contact name and phone: ( ) 440-3217 (7/03/DCBS/WCD/WEB)

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