| Section Name | Field Name | Field and/or Section Description |
| Use this form to apply for Workers’ Compensation insurance to the Michigan Workers’ | ||
| Compensation Placement Facility. Instructions for completing this application can be | ||
| found in the Michigan Workers’ Compensation Placement Facility’s Information and | ||
| TITLE | Michigan Application for Workers’ | Procedures Handbook. This handbook is available from the Michigan Worker’s |
| ACORD 133 MI (2009/02) | Compensation Insurance | Compensation Placement Facility or at www.caom.com. |