INDIVIDUAL SELF-INSURANCE APPLICATION CHECKLIST Forms
| Form Name | INDIVIDUAL SELF-INSURANCE APPLICATION CHECKLIST |
| Form # | WC-128 |
| Form Revision | (04-24) |
| Category | Forms » Insurance |
| Downloads | |
| Form State | Missouri |
| Language | English |
| State Description | The checklist of required items and information that must accompany the Application for Authority to Self-Insure (WC-81). |
| Claimwire Description | n/a |