Acknowledgement of Security Interest

Document Information
  How to complete a fillable form.
Title Acknowledgement of Security Interest
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.
Document number F207-143-000
How to get this document
Alt Language(s)
Valid dates 08/1996
Contact information Self-Insurance
Websites Insurance for Business , Self-Insured Employers

End of main content, page footer follows.

Access Washington official state portal

  © Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.