Agent Forms

2025 NCCI Miscellaneous Values & Payroll Limitations

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Industrial Aviation Aid Questionnaire

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Labor Subcontractor Supplemental Employee Leasing Application

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Group Transportation Questionnaire

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Personal Guaranty

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People Building Their Own Homes Voluntary Coverage Acknowledgement

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Payroll Reporting Awareness

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Non-Election Notice

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Statement of No Loss (ACORD 37)

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LWCC Audit Dispute Form

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Change of Name or Ownership Request for Information (ERM-14)

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W-9 Request for Taxpayer Identification Number and Certification

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LWCC Agent of Record Letter Form

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Agent/Broker of Record Change (ACORD 36)

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Workers Compensation Application (ACORD 130)

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Cancellation Request/Policy Release (ACORD 35)

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Certificate of Insurance (ACORD 25)

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