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Document Number: WKC-19003-E
Description: This form is required to be filed when a client of an employee leasing company terminates its election to provide worker's compensation insurance coverage for its leased employees.
Comments: This form is an electronic pdf template that can be filled out on your computer.
Content Contact: WC Insurance. This mailbox does not accept attachments.
Document Attachment: WKC-19003-E (Electronic Version - pdf/705 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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