ACORD 135NC (2012/10) - North Carolina Workers Compensation Insurance Plan Application for Designation of an Insurance Company

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The ACORD 135NC (2012/10) form, titled North Carolina Workers Compensation Insurance Plan Application for Designation of an Insurance Company, is used by businesses in North Carolina to apply for the designation of a specific insurance company to provide workers' compensation coverage under the state’s Workers' Compensation Insurance Plan. This form enables employers to select an insurance carrier and ensure that their workers' compensation coverage is in place, adhering to the requirements of the North Carolina Industrial Commission and state regulations.

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