Document Number: WKC-7602-E
Description: This form is used by a closely held corporation having no more than two corporate officers and no other employees that elects not to be covered by the Wisconsin Worker's Compensation Act by completing and filing the form with the WC division.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word). If you do not have Microsoft Word we are providing a PDF (WKC-7602) which you can print and complete by hand.
Content Contact: Lynn Weinberger
WKC-7602-E (Electronic Version - Word/45 KB)
WKC-7602 (Print Version - pdf/18 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.