ACORD 63UT Instructions

ACORD 63 UT (9/93) – Utah Fraud Statement

Utah law requires that the fraud statement language in ACORD 63 UT must be provided to every applicant for Workers Compensation Insurance, and must be included with every workers compensationinsurance claims form.

Use ACORD 63 UT with ACORD 4, Workers Compensation First Report of Injury or Illness, for claims, and ACORD 130, Workers CompensationApplication, for insureds in Utah.