Texas Department Of Insurance Form Dwc005

Division of workers compensation insurance coverage ms 96 7551 metro center drive suite 100 austin texas 78744 1645.

Texas department of insurance form dwc005. Box 149104 austin tx 78714 512 676 6000 800 578 4677. Austin tx 78744 1645 800 372 7713 phone 512 804 4146 fax. Who must file the dwc form 005. Dwc005 form used for non subscriber filings.

Public insurance adjuster bond licensing certifies that the persons listed on the form are bound to the texas department of insurance in the sum of 10 000 as specified at 28 texas administrative code 19 705. 3 11 2019 1 27 18 pm. Texas department of insurance. Do not have workers compensation insurance or you have terminated your workers compensation insurance coverage however if your only employees are exempt from coverage under the texas workers compensation act for example certain domestic workers certain farm and ranch workers you do not have to file.

7551 metro center drive suite 100 ms 96. You must file the dwc form 005 if you. Texas department of insurance 333 guadalupe austin tx 78701 p o. Box 149104 austin tx 78714 512 676 6000 800 578 4677.