Virginia Forms
9 State Forms found
| name | number | revision | print or send online | |
|---|---|---|---|---|
Annual Payroll Report of City, Town or County Operating as a Self-Insurer |
FORM 26C | 7/6/2011 | ||
Employer's Application for Individual Self-Insurance Under the Virginia Workers' Compensation Act |
VWC Form No. SI20 | (rev. 11/6/17) | ||
Self-Insurance Bond |
VWC Form No. 21-A | (rev. 1/1/92) | ||
Contractor's Certificate of Workers' Compensation Insurance |
Form 61A | rev 03/08/2024 | ||
OFFICER / MANAGER REJECTION OF COVERAGE |
16A | Rev. 01/25 | ||
Referral for Lack of Coverage |
Form 62 | No Form/Rev Date | ||
ANNUAL SURVEY OF INDIVIDUAL SELF-INSURERS |
VWC Form No. SI 23A | January 6, 2020 | ||
ANNUAL SURVEY OF INDIVIDUAL SELF-INSURERS-PUBLIC |
VWC Form No. SI 23B | January 6,2020 | ||
Detailed Claims Addendum for Claims in Excess of $100000 |
No Form Number | (Rev. 9/1/22) | ||
Disclaimer: These forms may not be the most recent version. Virginia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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