Get Wifdra Designated Contact Form - Wcrb.org - Wcrb

The WIFDRA Designated Contact Form is an essential document required by all carriers to maintain accurate and timely financial data submissions with WCRB. This guide provides clear instructions on how to complete the form efficiently, ensuring all critical information is captured correctly.

Follow the steps to fill out the form online with ease.

1. Press the ‘Get Form’ button to obtain the WIFDRA Designated Contact Form and open it for edit.
2. In the 'Group Name' field, enter the official name of your carrier group as it appears in your records.
3. For 'NCCI Carrier Code(s)', input the relevant code or codes associated with your carrier, ensuring accuracy.
4. In the 'Company Name(s)' section, list all applicable company names related to your carrier group, each on a new line.
5. Fill in the 'Contact Name' field with the full name of the designated contact person responsible for communication with WCRB.
6. Indicate the 'Title' of the contact person. This could be roles such as manager, director, etc.
7. Enter the email address of the contact person in the provided field, which will be used for communication regarding financial calls.
8. Provide a contact phone number where the designated contact can be reached.
9. If applicable, include a fax number for correspondence.
10. Fill in the 'Street Address', 'City', 'State', and 'Zip Code' to provide the complete address of the designated contact.
11. Review all entered information for accuracy to ensure that the document is complete and correct.
12. Once all fields are complete, you can save changes, download the form, print it, or share it as needed.

Complete your WIFDRA Designated Contact Form online to ensure compliance with WCRB requirements.