 |
Applications
Please
print, fill out, sign, and submit all pages to MOC.
| Mail
To: |
Or
Fax To: |
MOC
Insurance Services
Attn: DTHA
44 Montgomery Street, 17th Floor
San Francisco, CA 94104 |
(415)
957-0577
|
Please include
three
years of detailed loss history from your prior workers’ compensation
insurance carrier if new to the program.
2007-2008
DTHA Application
1)
DTHA Workers' Compensation Application
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