Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification

Agreement of Assumption and Guarantee of Workers'' Compensation Liabilities - Application of Certification - (Forms/Publications)
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Title Agreement of Assumption and Guarantee of Workers'' Compensation Liabilities - Application of Certification (A fillable form - 122 KB PDF)
Description

Used by an employer to apply for self-insurance.

Detail
Form number F207-040-000
Availability
Online only. See document above to download.
Keywords industrial insurance, liability, self insurance, self insurer, self-insurer, subsidiary, undersigned, worker's compensation, workers compensation
Languages English
Valid dates 11-2000
Contact information Self-Insurance
Web pages Self-Insured Employers

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