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Texas Department of Insurance
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TEXAS DEPARTMENT OF INSURANCE

Group/Company Name: ________________________________

Workers' Compensation Revised Relativities
Notice of Carrier Intent
Page 1

Notice of Carrier Intent

Company Name NAIC # (1)
Current
Deviation
(2)
Rate
Change
(3)
Off-balance
Factor
(4)
Deviation from
1/1/99 Relativities
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Attachment 3

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Last updated: 9/6/2014