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Get NY OC-409

PEAR ON BEHALF OF OR REPRESENT CARRIERS AND/OR SELF INSURERS [SECTION 50 (3-b/d) OF THE WORKERS’ COMPENSATION LAW] APPLICATION IS MADE UNDER (CHECK ONE): “ Section 24-a with fee “ Section 50 (3-b) “ Section 24-a without fee “ Section 50 (3-d) Note: Applicants failure to disclose fully and accurately any fact or information called for by any question may result in the denial of the application for a license, or if the license has been issued prior to the discovery thereof, the licen.

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