Acknowledgement of Security Interest
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| 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. | |
| Detail | ||
| Form number | F207-143-000 | |
| Availability | 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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