Forms/Laws
  • Home /
  • Indiana Forms

Indiana Forms

Change State
Forms » Insurance  
 

 17 State Forms found

name number revision print or send online

WORKER'S COMPENSATION AND OCCUPATIONAL DISEASES ACTS EMPLOYER'S APPLICATION FOR PERMISSION TO CARRY RISK WITHOUT INSURANCE

 FORM SI-1 (Revised 2018)

CERTIFICATION FOR WORKER’S COMPENSATION CARRIERS (Calendar Year 2020)

 State Form 12386-b Calendar year 2020

SELF-INSURED EMPLOYER CERTIFICATION (Calendar Year 2020)

 State Form 12386 calendar year 2020

WORKER'S COMPENSATION AND OCCUPATIONAL DISEASES ACTS CERTIFICATE OF EXCESS INSURANCE

 SI-3 (Revised 2003)

NOTICE FOR WORKER'S COMPENSATION AND OCCUPATIONAL DISEASES COVERAGE - EDI only

 State Form 36097 (R8 / 6-15)

WORKER'S COMPENSATION AND OCCUPATIONAL DISEASES ACTS EMPLOYER'S REQUEST TO INCLUDE A SUBSIDIARY WITHIN ITS SELF-INSURANCE PROGRAM

 SI-5 Revised 2012

TRUCKERS SUPPLEMENTAL APPLICATION

 Form SI-7 (Revised 2003)

CERTIFICATION OF INSURANCE CARRIER AS TO NUMBER OF WORKERS' COMPENSATION POLICIES WRITTEN OR RENEWED

 State Form 55310 (R / 6-13)

CERTIFICATION FOR WORKER’S COMPENSATION CARRIERS (Calendar Year 2017)

 State Form 12386-b calendar year 2017

CERTIFICATION FOR WORKER’S COMPENSATION CARRIERS (Calendar Year 2018)

 State Form 12386-b calendar year 2018

CERTIFICATION FOR WORKER’S COMPENSATION CARRIERS (Calendar Year 2021)

 State Form 12386-b calendar year 2021

SELF-INSURED EMPLOYER CERTIFICATION (Calendar Year 2019)

 State Form 12386 calendar year 2019

CERTIFICATION FOR WORKER’S COMPENSATION CARRIERS (Calendar Year 2022)

 State Form 12386-b Calendar Year 2022

SELF-INSURED EMPLOYER CERTIFICATION (Calendar Year 2024)

 State Form 12386 calendar year 2024

CERTIFICATION FOR WORKER’S COMPENSATION CARRIERS (Calendar Year 2024)

 State Form 12386-b Calendar year 2024
Disclaimer: These forms may not be the most recent version. Indiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
Loading results ...
Origami Risk
1379 N 1075 W, Suite 226,
Farmington, UT 84025
312.546.6515
info@origamirisk.com
© 2025 Origami Risk. All Rights Reserved.