Self-Insurers Agreement To Post Letter Of Credit Schedule Of Supplement {IC73}

IC73 - SELF-INSURER’S AGREEMENT TO POST LETTER OF CREDIT SCHEDULE OF SUPPLEMENT. This form is used by an employer to document and supplement letters of credit deposited with the Commission as part of maintaining self-insurance status. This form is attached to the original Self-Insurer’s Agreement to Post Letter of Credit and records the details of any new or additional letters of credit, including the issuing bank, confirmation bank (if any), amounts, and reference numbers. By completing this form, the employer agrees that the deposited letter(s) of credit will be held by the Commission under the same terms and conditions as the original agreement. www.FormsWorkflow.com