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Application For A WorkSafe Insurance Policy Form

  • Registration for WorkCover Insurance Form (PDF 293kb)
    Document Type: Form
    Keycode: FOR554/09/01.14
    Industry: Local Government, 
    Category: Insurance and Premiums, 
    Publication Date: 2 July 2014
    Date First Published: 11 October 2006
    Summary: This form is used to apply for a WorkSafe Injury Insurance Policy. On completion this form should be sent to one of the five WorkSafe Agents.