Legal Forms >> Michigan >> Workers' Compensation

LEGAL FORMS

Insurer's Notice of Name or Address Change

MI-WC-0403
This form is used to report to the Michigan Workers' Compensation Agency a) an employer's name or address change, b) a deletion or addition of a division of the employer, or c) a name change or address change of a division of the employer.

Insurer's Notice of Name or Address Change
MI-WC-0403
Michigan

Workers' Compensation

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$13.99 /ea.
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