ACORD 133TN Instructions


ACORD 133 TN (2004/09) – Tennessee Workers CompensationInsurance Plan Assigned Risk Supplement

Use this form together with ACORD 130, Workers CompensationApplication, to apply for workers compensation insurance to the Tennessee Workers Compensation Insurance Plan.

For Rating Information and Plan Rules and Factors, go to the Tennessee Workers Compensation Insurance Plan web site at www.twcip.com.