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Get NY DB-850 2002-2024

: Chair, Workers' Compensation Board _____________________________________________________________________________________, an insurance carrier authorized by the Superintendent of Insurance to write contracts insuring the obligations of employers pursuant to Section 211 of the Workers' Compensation Law, hereby applies under Section 360.1(b)(1) NYCRR for the acceptance of the attached insurance form, and requests assignment of an identifying number. 1. The attached form is: Policy Rider or En.

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