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Document Number: WKC-7602-E
Description: This form is used by a closely held corporation having no more than two corporate officers and no other employees that elects not to be covered by the Wisconsin Worker's Compensation Act by completing and filing the form with the WC division.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word). An electronic PDF (WKC-7602-E) is also provided for your convenience.
Content Contact: Lynn Weinberger
Document Attachments:
WKC-7602-E (Electronic Version - Word/46 KB)
WKC-7602-E (Electronic Version - pdf/183 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.
DWD Contact Information
201 E. Washington Ave
P.O. Box 7946
Madison, WI 53707
(608) 266-3131
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