SELF-INSURED EMPLOYER CERTIFICATION (Calendar Year 2024) Forms
| Form Name | SELF-INSURED EMPLOYER CERTIFICATION (Calendar Year 2024) |
| Form # | State Form 12386 |
| Form Revision | calendar year 2024 |
| Category | Forms » Insurance |
| Downloads | |
| Form State | Indiana |
| Language | English |
| State Description | n/a |
| Claimwire Description | The URL provided directs you to Indiana's Workers' Compensation Board, from which you will be able to access the specific form. |