Loading
Get Wc12 Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Wc12 Form online
The Wc12 Form is essential for requesting a rebate from the Multiple Injury Trust Fund in Oklahoma. This guide provides a clear, step-by-step approach to completing the form online, ensuring that users can navigate the process smoothly.
Follow the steps to fill out the Wc12 Form online
- Click the ‘Get Form’ button to access the Wc12 Form and open it in your preferred editing software.
- Enter the name of the own risk employer or insurance carrier in the designated field.
- Input the Federal Employer’s Identification Number accurately in the corresponding field.
- Provide the street address, city, state, and zip code of the employer or insurance carrier in the appropriate sections.
- In line 1, enter the total Multiple Injury Trust Fund payments received.
- Calculate 2/3 of the amount entered on line 1 and list this rebate request in line 2.
- Sign the certification statement to confirm that the information is true and that you are authorized to submit this request.
- Fill in the printed name and title of the individual signing the form, along with a contact telephone number.
- Review the completed form for accuracy before finalizing.
- Once completed, you can save your changes, download the form, print it, or share it as needed.
Complete your Wc12 Form online today to ensure your rebate request is submitted on time.
The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.