Surety Bond Approved Securities / Parent Company Address (b) Parent Company / /
Currency
USD / /
Facility
Disability Compensation Division Princess Keelikolani Building / STATE OF HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DISABILITY COMPENSATION DIVISION Princess Keelikolani Building / /
IndustryTerm
insurance policy / compensation insurance / proposed self-insurance plan / self-insurance program / /
Organization
Department of Labor / Self Insurer’s Own Organization / Claims administration / Own Organization / Industrial Relations / Disability Compensation Division / DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DISABILITY COMPENSATION DIVISION Princess Keelikolani Building / OF HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DISABILITY COMPENSATION DIVISION / / /
Position
Director / Hawaii 96813 FORM WC-21 APPLICATION FOR SELF-INSURANCE AUTHORIZATION To / Director / Princess / Administrator / /