Application for Group Retrospective Rating

Document Information
  How to complete a fillable form.
Title Application for Group Retrospective Rating

Used by organizations to set up an agreement with L&I authorizing their participation in retrospective rating.

Document number F250-004-000
How to get this document
Alt Language(s)
Valid dates 09/2014
Contact information Contact Us About Retrospective Rating
Related information
Documents Application for Group Membership & Authorization for Release of Insurance Data
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