Forms, Endorsements, WCPAP Application, Notification Forms - Wisconsin Compensation Rating Bureau

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Endorsements

Endorsements Acceptable in Wisconsin - Standard endorsements accepted in Wisconsin

Endorsements N/A in Wisconsin - Listing of endorsements not accepted in Wisconsin

Reporting and Miscellaneous Requests

Bureau Request Form - Request employer specific information such as rating or experience modification data, inspection reports, etc.

Business Operations Report - Insureds use to provide self inspection business operation details

Employer 'FindMyMod' Access Request - Misplaced your Employers Experience Rating access instruction letter? Request WCRB to resend.

ERM-6 (12/7/04) - Self-insureds use to submit experience rating data

ERM-14 (12/7/04) - Insureds use to report ownership changes

Information Release Authorization Form - IRAF (5/9/06) - Allows insureds to authorize WCRB to release information to a designated entity

Pool Payroll Report - Pool policy holders create a Pool Payroll Report

WCRB Web Membership

Authorizing Officer Change Form - Replace the existing Authorizing Officer for your organization

Group Administrator Change Request - Replace the existing Group Administrator for your organization

WCRB Group Administrator Web Account Registration - Complete to establish a WCRB Web site membership

Web Site Member User Guide - User Guide for WCRB Web site members and a listing of products afforded to each membership level

Wisconsin Worker's Compensation Insurance Pool

ACORD 134 WI - Wisconsin Supplementary Non-Election Form

ACORD 135 WI - Wisconsin Supplementary Election of Coverage Form

ACORD 136 WI - Wisconsin Supplementary Limited Other States Coverage Request

WI Pool V 1.0 - Wisconsin Worker's Compensation Insurance Pool hard copy application

Wisconsin Contractors Premium Adjustment Program (WCPAP)

WCPAP.ED11 - WCPAP Premium Credit Factor Online Application

For assistance, please call 262-796-4593

WCPAP-ED02-16-17 - WCPAP Carrier Audit Form

Worker's Compensation and Employer's Liability Policy

ACORD 130 (2013/09) - Workers Compensation and Employers Liability Insurance Policy application (Application Form WI Pool V 1.0 must be used for Pool business)

ACORD 130 (2017/05) - Workers Compensation and Employers Liability Insurance Policy application (Application Form WI Pool V 1.0 must be used for Pool business)

ACORD 101 (2008/01) - Additional Remarks Schedule

WC 00 00 00 C (Ed. 1-15) - Worker's Compensation and Employers Liability Insurance Policy language

WC 00 00 01 A - Information Page - Worker's Compensation and Employers Liability Insurance Policy information page

WC 00 00 01 A - General Information Page Notes - General Information Page Notes

WC 00 00 01 C - Information Page Notes - Information Page Notes

Wisconsin Proof of Coverage (48-2) - For use when providing evidence of coverage on a rewritten policy which is not immediately available

Wisconsin Compensation Rating Bureau

Wisconsin Compensation
Rating Bureau

Proudly Serving Wisconsin Since 1917

Employer Forms