Acknowledgement of Security Interest

Acknowledgement of Security Interest - (Forms/Publications)
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Title   Acknowledgement of Security Interest (74 KB PDF)
Description Used to acknowledge that funds have been deposited into an account at a bank for the purpose of providing payment for the workers' compensation benefits and assessments in the event of default by the self-insurer.
Form number F207-143-000
Online only. See document above to download.
Keywords deposit account, industrial insurance, interest, self insurance, self insurer, self-insurance, worker's compensation, workers compensation
Languages English
Valid dates 08-1996
Contact information Self-Insurance
Web pages Insurance for Business
Self-Insured Employers

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