Application for Self-Insurance Certification

Application for Self-Insurance Certification - (Forms/Publications)
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Title Application for Self-Insurance Certification (A fillable form - 113 KB PDF)

Used by employers to apply for self-insurance certification.

Form number F207-001-000
Online only. See document above to download.
Keywords applicant, certificate, certified, industrial insurance, self insurance, self insurer, self-insurer, worker's compensation, workers compensation, workers' compensation
Languages English
Valid dates 09-2006
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Web pages Insurance for Business
Self-Insured Employers

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