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Get WA F101-009-000 2018-2024

Requestor Name Representing / On Behalf Of Company Name UBI Number / License Number Mailing Address City State Phone Number Fax Number Zip Code Email Address Check the box(es) for the record(s) needed: Claim File** See Claim & Account Center Contractor Records Crime Victims File** Factory Assembled Structures Records Fraud Investigation Records IME Provider Records (credentialing, complaints, reviews, etc.) DOSH Discrimination Complaint for reporting a Industrial Insurance Dis.

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