CERTIFICATION OF INSURANCE CARRIER AS TO NUMBER OF WORKERS' COMPENSATION POLICIES WRITTEN OR RENEWED Forms
| Form Name | CERTIFICATION OF INSURANCE CARRIER AS TO NUMBER OF WORKERS' COMPENSATION POLICIES WRITTEN OR RENEWED |
| Form # | State Form 55310 |
| Form Revision | (R / 6-13) |
| Category | Forms » Insurance |
| Downloads | |
| Form State | Indiana |
| Language | English |
| State Description | Notice: Effective 6/19/2013, per HEA1320, all carriers should complete State Form 55310 and submit, along with a check, to the Worker’s Compensation Board. |
| Claimwire Description | n/a |