Michigan Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form)

• Category: Michigan Workers Compensation - Official
• State: Michigan
• Control #: MI-WC-402A
• Format: PDF

Description

Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form) The Michigan Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form) is a document used by employers who are self-insured in Michigan to add or delete a subsidiary or affiliate from their existing self-insurance status. This document contains specific information about the subsidiary/affiliate, including legal name, address, contact person, contact information, insurance coverage, and other relevant information. The Michigan Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form) must be completed and submitted to the Michigan Department of Licensing and Regulatory Affairs for review and approval. There are two types of Michigan Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form): one for adding a subsidiary/affiliate and one for deleting a subsidiary/affiliate. The form for adding a subsidiary/affiliate requires the employer to provide detailed information about the subsidiary/affiliate, including its legal name, address, contact person, contact information, insurance coverage, and other relevant information. The form for deleting a subsidiary/affiliate requires the employer to provide the legal name, address, contact person, and contact information of the subsidiary/affiliate that is being deleted. Both forms must be signed by an authorized representative of the employer. Upon submission of the forms to the Michigan Department of Licensing and Regulatory Affairs, the forms will be reviewed and approved or denied.

The Michigan Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form) is a document used by employers who are self-insured in Michigan to add or delete a subsidiary or affiliate from their existing self-insurance status. This document contains specific information about the subsidiary/affiliate, including legal name, address, contact person, contact information, insurance coverage, and other relevant information. The Michigan Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form) must be completed and submitted to the Michigan Department of Licensing and Regulatory Affairs for review and approval. There are two types of Michigan Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form): one for adding a subsidiary/affiliate and one for deleting a subsidiary/affiliate. The form for adding a subsidiary/affiliate requires the employer to provide detailed information about the subsidiary/affiliate, including its legal name, address, contact person, contact information, insurance coverage, and other relevant information. The form for deleting a subsidiary/affiliate requires the employer to provide the legal name, address, contact person, and contact information of the subsidiary/affiliate that is being deleted. Both forms must be signed by an authorized representative of the employer. Upon submission of the forms to the Michigan Department of Licensing and Regulatory Affairs, the forms will be reviewed and approved or denied.