Self-Insurers Escrow Agreement Amendment {IC63}

IC63 - SELF-INSURER’S ESCROW AGREEMENT AMENDMENT. The Illinois Workers’ Compensation Commission is used to make changes to an existing Self-Insurer’s Escrow Agreement between an employer and an escrow agent. This form allows for updates such as changing the employer’s name, adjusting the escrow amount, or adding or removing an employer from the agreement. It must be attached to the original escrow agreement and does not alter any of its provisions except for the specific modifications stated in the amendment. The form requires signatures from the employer’s representative, the escrow agent’s representative, and an attestant, along with corporate seals, ensuring that the changes are formally authorized and legally binding. www.FormsWorkflow.com