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We provide this form online to get information from you, or update information you already gave us. If a new division (assumed name or DBA) is to be added to an existing policy, a Form WC-403, Insurer's Notice of Name or Address Change, must.Enter the employer's name, if applicable. If there is a change in the insured's insurance status, e.g. INSURANCE REPARATIONS ACT (NO-FAULT LAW). Enter your name, EIN, and complete mailing address. Form nameVersion dateNotesAffidavit of Significant Financial Hardship (AS01)June 2018Legislative changesDisability Status Report (DS01)September 2012Employee's Claim Petition (EC04)June 2018Legislative changes The FMCSA does not furnish copies of insurance forms. Need help opening Insurance Forms? How Do I Submit Proof of Insurance to the BMV Using the EIFs Program?