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FREQUENTLY USED FORMS

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Form Title (click PDF icon to open) NJ Manual Reference
Acceptance of Bureau Membership and Designation
Acceptance of New Jersey Workers Compensation Insurance Plan
New Jersey Workers Compensation Insurance Plan Instructions and Rules ACORD 132NJ (9/2015)
New Jersey Workers Compensation Insurance Plan Application For Designation Of An Insurance Company ACORD 133NJ (9/2015)
New Jersey Workers Compensation Insurance Plan Notice Of Election - Proprietors and Partners ACORD 134NJ (9/2015)
New Jersey Workers Compensation Insurance Plan Client Supplemental Employee Leasing Application ACORD 135NJ (9/2015)
New Jersey Workers Compensation Insurance Plan Truckers Supplemental Application ACORD 136NJ (9/2015)
Posting Notice Form 16 NJ (4/2000)
Large Risk — Large Deductible Program Notice Of Election (Effective 7/1/06) Form NJ LR-LD (6th Rev)
New Jersey Notice Of Election — Retrospective Rating Form NJRR-1 (8th Rev)
New Jersey Notice Of Election — Retrospective Rating (Effective 1/1/16) Form NJRR-2
New Jersey Notice Of Election — Proprietors And Partners Workers Compensation and Employers Liability Insurance Form PP-1B
Application for An Approved Managed Care Program Premium Reduction Form #Req 11:6-2.3(d)
Experience Rating Data Form - Front XM1-2014
Experience Rating Data Form - Back - Instructions Form XM1-2014
Primary Unit Statistical Reporting Form USR-ASWG Form A
New Jersey CRIB Hard Copy Transmittal Letter (Form TL-1) Transmittal Letter (Form TL-1)
New Jersey - Letter of Transmittal (Form S-30NJ - tape submission only) Letter of Transmittal (Form S-30NJ)
New Jersey - Letter of Transmittal (Form S-31NJ) Letter of Transmittal (Form S-31NJ)
Cancellation Form (Form 116-B) Cancellation (Form 116-B)
Reinstatement Form (Form 117-A) Reinstatement (Form 117-A)