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

Carrier Elections - Provide carrier election information. The Carrier Election member product is only available to carrier members. Please contact the Group Administrator for your carrier group to request access to this member product.

Filing Option Election Form

Complete and submit to file unit statistical data directly with WCRB

Endorsements Acceptable in Wisconsin

Standard endorsements accepted in Wisconsin

Endorsements N/A in Wisconsin

Listing of endorsements not accepted in Wisconsin

Bureau Request Form

Request employer specific information such as rating or experience modification data or five-year premium and loss exhibit, etc.

Electronic ERM-14

Insureds use to report ownership changes

Hardcopy ERM-14

Insureds use to report ownership changes

Inspection Request

Request an on-site operational review of the insured’s business

Premium Writing Request

Carriers report annual workers compensation premium writing

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

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

WCPAP.ED11

WCPAP Premium Credit Factor Online Application

For assistance, please call 262-796-4593

WCPAP-ED02-16-17

WCPAP Carrier Audit Form

ACORD 101 (2008/01)

Additional Remarks Schedule

ACORD 130 (2017/05)

Workers Compensation Application

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

CKE-1167M (01-15)

Specific Excess Workers Compensation and Employers Liability Policy

00 GL0253 50 (04 15)

Terrorism Risk Insurance Program Reauthorization Act Disclosure

EX 00 01 09 08

Excess Policy for Self Insured

00 GL0367 50 (05 15)

Designated Workplaces Exclusion Endorsement

WCE 90 00 03 (SC) Ed. 01/96

Specific Excess and Aggregate Excess

00 GL0368 50 (04 15)

Excess Voluntary Compensation and Employers Liability Coverage Endorsement

WC 99 05 57 (01-15)

Cancellation Form

00 GL0403 50 (05 15)

Amendatory Endorsement

WC 99 05 64 (07-15)

Reporting of Data on Claims

WC 99 06 T5 (00)

Catastrophe Premium Endorsement

WC 99 06 T6 (00)

Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement

XS WC 0001-0002 WI (10/14)

Excess Workers Compensation & Employers Liability Coverage Form

XWC 202-XLSP 0813

Stop Gap Insurance Endorsement

XWC 223-XLSP 813

Maritime Coverage Endorsement

Carrier Forms

Carrier Contact Preferences

Carrier Notification Preference

WCRB Business Contact Form

*NEW* WCRB Medical Data Call Contact Form

WIFDRA Designated Contact Form

Carrier Elections