EXEMPTION PROVISION WAIVER Forms
| Form Name | EXEMPTION PROVISION WAIVER |
| Form # | 440-4965 |
| Form Revision | 2/21 |
| Category | Forms » Legal/Fraud |
| Downloads | |
| Form State | Oregon |
| Language | English |
| State Description | For use by the self-insured employer to permit DCBS to discuss confidential self-insurance information with their specified agents, brokers, or consultants. |
| Claimwire Description | n/a |