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Get Ga Wc131a

T the undersigned applicant has heretofore been licensed by the Insurance Commissioner of Georgia to write workers compensation insurance, and has complied with the provisions of the laws of the State of Georgia regulating insurance companies, under the provisions of the Georgia Workers Compensation Act. Send this form, accompanied by current GA Certificate of Authority, to the State Board of Workers Compensation, 270 Peachtree Street NW, Atlanta, GA 30303-1299. SECTION A. CORPORATE /.

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