Field and/or Section Description
ACORD 133 MI (2009/02)
Michigan Application for Workers'
Use this form to apply for Workers' Compensation insurance to the Michigan Workers'
Compensation Placement Facility. Instructions for completing this application can be
found in the Michigan Workers' Compensation Placement Facility's Information and
Procedures Handbook. This handbook is available from the Michigan Worker's
Compensation Placement Facility or at www.caom.com.
ACORD 133 MI (2009/02) rev. 03-31-2009
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