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

State:
Michigan
Control #:
MI-WC-402A
Format:
PDF
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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.

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SELF-INSURER REQUEST. Self-Insurer Applicant: Application for workers' disability compensation self-insured authority is made on Form WC-402.Questions 1through 10 must be completed. Sub Application: add a subsidiary or affiliate to an existing approved application. ➢ Completed Affiliate application (Form A-3B (1-2016)). SI-6S, Application to Add a Subsidiary to an Existing Self-Insured Policy, pdf Print. How do I go about adding a subsidiary company to our self-insurers program? Private self-insurers in good standing are permitted to add new subsidiary or affiliate companies with an application for an interim certificate. Can I automatically be notified when new positions open? What is the Close Date on a job posting?

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