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Get Interactive Form 18 - The Phoenix Company

IN The I.C. File # is the unique identifier for this injury. It will be provided by return letter and is to be referenced in all future correspondence. The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act ( Employee s Name Employer's Name Address Employer s Address City ( State ) ( Zip M Social Security Number F / Sex Telephone Number City State Insurance Carrier Policy Number Carrier s Address City Carrier s Telephone Number Carrie.

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