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Document Number: WKC-18151-E
Description: This form is used for collecting pertinent information from new Workers' Compensation insurance carriers as well as updating changes in information. The form also provides a section to submit or update information pertinent to Third Party Administrators.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word). An fillable PDF (WKC-18151-E) is also provided for your convenience.
Content Contact: Lynn Weinberger
Document Attachments:
WKC-18151-E (Electronic Version - Word/27 KB)
WKC-18151-E (Electronic Version - pdf/86 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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