Arizona Notice Of Self-Insurers Termination Of Self-Insurance Form is a document used by employers in Arizona to terminate their self-insurance status and cease providing workers' compensation benefits to employees. This document must be completed and submitted to the Arizona Industrial Commission within 10 days of the termination of coverage. There are two types of Arizona Notice Of Self-Insurers Termination Of Self-Insurance Form: Form A and Form B. Form A is used to terminate self-insurance for a single employer, while Form B is used to terminate self-insurance for multiple employers. Both forms require the employer to list the name, address, and date of termination of self-insurance, as well as the name and address of the insurance carrier that will assume responsibility for the workers’ compensation benefits.
Arizona Notice Of Self-Insurers Termination Of Self-Insurance Form
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How to fill out Arizona Notice Of Self-Insurers Termination Of Self-Insurance Form?
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