WORKERS COMPENSATION ENDORSEMENTS & POLICY FORMS

For questions regarding form filings, use this document as a reference guide:  WC Form Proposal Guidelines and FAQs

Form Number Description
WC 00 00 00C Workers Compensation and Employers Liability Policy  INSTRUCTIONS
WC 00 00 01A Workers Compensation and Employers Liability Policy Information Page & Extensions  INSTRUCTIONS
WC 00 01 01A Defense Base Act Coverage Endorsement  INSTRUCTIONS
WC 00 01 02B Federal Mine Health and Safety Act Coverage Endorsement  INSTRUCTIONS
WC 00 01 04A Federal Employers' Liability Act Coverage Endorsement  INSTRUCTIONS
WC 00 01 06A Longshoremen's and Harbor Workers' Compensation Act Coverage Endorsement  INSTRUCTIONS
WC 00 01 08A Nonappropriated Fund Instrumentalities Act Coverage Endorsement  INSTRUCTIONS
WC 00 01 09C Outer Continental Shelf Lands Act Coverage Endorsement  INSTRUCTIONS
WC 00 01 11 Migrant and Seasonal Agricultural Worker Protection Act Coverage Endorsement  INSTRUCTIONS
WC 00 02 01B Maritime Coverage Endorsement  INSTRUCTIONS
WC 00 02 03  Voluntary Compensation Maritime Coverage Endorsement  INSTRUCTIONS
WC 00 03 01A  Alternate Employer Endorsement  INSTRUCTIONS
WC 00 03 02  Designated Workplaces Exclusion Endorsement  INSTRUCTIONS
WC 00 03 03C  Employers Liability Coverage Endorsement  INSTRUCTIONS
WC 00 03 04  Insurance Company as Insured Endorsement  INSTRUCTIONS 
WC 00 03 05  Joint Venture as Insured Endorsement  INSTRUCTIONS
WC 00 03 08  Partners, Officers and Others Exclusion Endorsement  INSTRUCTIONS
WC 00 03 09B  Rural Utilities Service Endorsement  INSTRUCTIONS
WC 00 03 10  Sole Proprietors, Partners, Officers and Others Coverage Endorsement  INSTRUCTIONS
WC 00 03 11A  Voluntary Compensation and Employers Liability Coverage Endorsement  INSTRUCTIONS
WC 00 03 12A  Voluntary Compensation and Employers Liability Coverage for Residence Employees Endorsement  INSTRUCTIONS
WC 00 03 13  Waiver of Our Right to Recover from Others Endorsement  INSTRUCTIONS
WC 00 03 14A  Workers Compensation and Employees Liability Coverage for Residence Employees Endorsement  INSTRUCTIONS
WC 00 03 15  Domestic and Agricultural Workers Exclusion Endorsement  INSTRUCTIONS
WC 00 03 25  Residual Market Multiple Company Endorsement  INSTRUCTIONS
WC 00 03 26A  Residual Market Limited Other States Insurance Endorsement  INSTRUCTIONS
WC 00 04 03  Experience Rating Modification Factor Endorsement  INSTRUCTIONS
WC 00 04 04  Pending Rate Change Endorsement  INSTRUCTIONS
WC 00 04 05  Policy Period Endorsement  INSTRUCTIONS
WC 00 04 06A  Premium Discount Endorsement  INSTRUCTIONS
WC 00 04 07  Rate Change Endorsement  INSTRUCTIONS
WC 00 04 12  Contingent Experience Rating Modification Factor Endorsement  INSTRUCTIONS
WC 00 04 14A 90-Day Reporting Requirement - Notification of Change in Ownership Endorsement  INSTRUCTIONS
WC 00 04 19 Premium Due Date Endorsement  INSTRUCTIONS
WC 00 04 19A  Part Five - Premium Amendatory Endorsement effective 8/1/2022  INSTRUCTIONS
WC 00 04 21E Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement  INSTRUCTIONS
WC 00 04 21F Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement effective 8/1/2022  INSTRUCTIONS
WC 00 04 22C Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement  INSTRUCTIONS
WC 00 04 24 Audit Noncompliance Charge Endorsement  INSTRUCTIONS
WC 00 04 25  Experience Rating Modification Factor Revision Endorsement  INSTRUCTIONS
WC 00 05 03 D  Retrospective Premium Endorsement One Year Plan  INSTRUCTIONS
WC 00 05 04 D  Retrospective Premium Endorsement Three Year Plan  INSTRUCTIONS
WC 00 05 05 D  Retrospective Premium Endorsement Wrap-Up Construction Project  INSTRUCTIONS
WC 00 05 08  Retrospective Premium Endorsement Aviation Exclusion  INSTRUCTIONS
WC 00 05 09A  Retrospective Premium Endorsement Changes  INSTRUCTIONS
WC 00 05 10B  Retrospective Premium Endorsement Non-Rateable Catastrophe Element or Surcharge  INSTRUCTIONS
WC 00 05 11  Retrospective Premium Endorsement Short Form  INSTRUCTIONS
WC 00 05 12 D  Retrospective Premium Endorsement One Year Plan - Multiple Lines  INSTRUCTIONS
WC 00 05 13 D  Retrospective Premium Endorsement Three Year Plan - Multiple Lines  INSTRUCTIONS
WC 00 05 14 D  Retrospective Premium Endorsement Wrap-Up Construction Project - Multiple Lines  INSTRUCTIONS
WC 00 05 15A  Retrospective Premium Endorsement Flexibility Options  INSTRUCTIONS
WC 00 05 16  Retrospective Rating Plan Premium Endorsement Large Risk Alternative Rating Option (LRARO)  INSTRUCTIONS
WC 00 06 03  Benefits Deductible Endorsement  INSTRUCTIONS
WC 32 03 01D North Carolina Amended Coverage Endorsement (eff 7/1/2018)  INSTRUCTIONS
WC 32 03 02   North Carolina Controlled Insurance Program - Amendatory Endorsement (Large Deductible Plans)  INSTRUCTIONS
WC 32 03 03  North Carolina Controlled Insurance Program - Amendatory Endorsement  INSTRUCTIONS
WC 32 03 04  Alternative Employer Endorsement (Excluding Employers Liability)  INSTRUCTIONS
WC 32 03 05 North Carolina Professional Employer Organization (PEO) Exclusion Endorsement  INSTRUCTIONS
WC 32 03 06  North Carolina Professional Employer Organization (PEO) Extension Endorsement  INSTRUCTIONS 
WC 32 03 07  North Carolina Professional Employer Organization (PEO) Client Exclusion Endorsement  INSTRUCTIONS 
WC 32 03 08  North Carolina Professional Employer Organization (PEO) Client Extension Endorsement  INSTRUCTIONS
WC 32 04 15 Assigned Risk Adjustment Program Endorsement  INSTRUCTIONS
WC 32 04 17 Assigned Risk Loss Sensitive Rating Plan Notification Endorsement  INSTRUCTIONS
WC 32 04 18 Assigned Risk Loss Sensitive Rating Plan Endorsement  INSTRUCTIONS
WC 32 06 01B Cancellation and Non-Renewal Endorsement  INSTRUCTIONS
WC 32 06 02  Pro-Rata Cancellation Endorsement  INSTRUCTIONS
WC 32 06 03 North Carolina Non-Insurance Goods and/or Services Endorsement  INSTRUCTIONS
WC 32 06 04 North Carolina Notice of Cancellation or Material Change to Designated Governmental Entity Endorsement  INSTRUCTIONS
WC 89 06 00B  Policy Information Page Endorsement  INSTRUCTIONS