EMPLOYER'S APPLICATION FOR THE PRIVILEGE OF PAYING COMPENSATION PROVIDED IN THE MISSISSIPPI WORKERS' COMPENSATION ACT AS SELF-INSURER Forms
| Form Name | EMPLOYER'S APPLICATION FOR THE PRIVILEGE OF PAYING COMPENSATION PROVIDED IN THE MISSISSIPPI WORKERS' COMPENSATION ACT AS SELF-INSURER |
| Form # | A-2 |
| Form Revision | No Form/Rev Date |
| Category | Forms » Insurance |
| Downloads | |
| Form State | Mississippi |
| Language | English |
| State Description | This form should be filled out by those Employers seeking to become approved as Self-Insurers by the Commission, (General Rule 7). |
| Claimwire Description | n/a |