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Get MA Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 2013

T: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_________________________________________________ _ Address:__________________________________________________________________________ City/State/Zip:_____________________________ Phone #:________________________________ Are you an employer? Check the appropriate box: 4. I am a general contractor and I 1. I am a employer with _________ have hired the sub-contractors .

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