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WC-400A (11/05) - Insurer's Notice of Issuance of Specific Risk Policy

This form is used to report insurance coverage for an employer covered under a specified construction site insurance policy and is not available online.  To find out whether you qualify for this form and obtain a copy, contact the Compliance & Employer Records Division at (517) 322-1195.
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Related Content
 •  WC-337 (4/04) Notice of Exclusion
 •  WC-338 (10/05) Notice to Terminate Exclusion
 •  WC-400 (9/05) - Insurer's Notice of Issuance of Policy (fill-in form) PDF icon
 •  WC-401 (11/05) - Notice of Termination of Liability (fill-in form) PDF icon
 •  WC-401A (11/05) - Notice of Termination of Specific Risk Policy
 •  WC-403 (11/05) - Insurer's Notice of Name or Address Change (fill-in form) PDF icon

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