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Get RI DWC-01 2003-2024

WC No. PO Box 20190, Cranston, RI 02920-0942 Phone (401) 462-8100 TDD (401) 462-8084 FAX (401) 462-8105 1. EMPLOYER LOCATION: Insurer File No. SAME AS BLOCK 1 2. EMPLOYER NAMED ON WC INSURANCE POLICY: FEIN FEIN Name Name Address Address City State Phone Zip Ext. City RI Unemployment Ins. No. State Ext. WC Policy Number NAICS 3. INSURANCE COMPANY NAMED ON WC POLICY: 4. CLAIM ADMINISTRATOR: FEIN FEIN Name Name Address Address Address Address City State Zip City Ph.

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