Designation Of Service Agent - Form 7
Download a blank fillable Designation Of Service Agent - Form 7 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Designation Of Service Agent - Form 7 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1FORM 7
COURT OF EXISTING CLAIMS
This space for Court Use only
1915 NORTH STILES
Send original to
OKLAHOMA CITY, OK 73105-4918
Court of Existing Claims
Designation of Service Agent
Pursuant to Court of Existing Claims Rule 10: When the claimant files a claim for compensation (Form 3, Form 3A or Form 3B), the Court
shall mail a file-stamped copy of the claim form bearing the assigned file number to a single service agent of the self-insured employer, group
self-insurance association, insurance carrier or CompSource Oklahoma which shall be designated on a Form 7 and filed with the Court. The
Court shall send all notices and correspondence to the service agent until an entry of appearance or notice of substitution of attorney is filed
pursuant to Rule 7. If no service agent is designated on the Form 7, notices and correspondence shall be sent to:
1.
The signatory on the self-insurance application, if the insurer is a self-insured employer;
2.
The Administrator of the group self-insurance association, if the insurer is a group self-insurance association;
3.
The person designated to receive notice of service of process for an insurer as provided in 36 O.S., Section 621, if the
insurer is a foreign or alien insurance carrier;
4.
The President and Chief Executive Officer of CompSource Oklahoma, if the insurer is CompSource Oklahoma; or
5.
The service agent on file with the Secretary of State, if the insurer is a domestic insurance carrier.
If the employer is uninsured or the Court cannot determine insurance coverage, notices and correspondence shall be sent by certified mail
to the employer's last known address.
The following information is required and must be amended whenever a change of service agent is made.
Please check (
) the appropriate box below
Name of:
Carrier
Self-Insured Employer
Group Self-Insurance Association
Home office mailing address:
City
State
Zip
Street Address, if different from mailing address:
Phone Number
Designated Service Agent
Name of Individual or Business:
Name of contact person, if the service agent is a business:
E-mail:
Mailing address:
City
State
Zip
Street Address, if different from mailing address:
Phone Number
Signed this ____________
____________
____________
____________ day of __________________,
__________________,
__________________,
__________________, __________
__________
__________
__________
Signature
I HEREBY CERTIFY THAT THIS DOCUMENT WAS
MAILED TO THE COURT OF EXISTING CLAIMS ON:
Prepared by _______________________________________________
_____________________________________, _______________
Title _____________________________________________________
C. 02/01/2014
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal