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CLAIM FORMS

For your convenience, the forms available on this page may be downloaded, filled in, and e-mailed back to us.


ACORD Reader
To use any of the ACORD documents on this page, you MUST have this file installed on your computer. To download, left-click on the filename and enter the information requested. Once the installation program is downloaded, run it, and follow the on-screen instructions.

ACORD Form #4 (Worker's Compensation Form)
To download, right-click on the filename, then choose Save Target As....

The Cincinnati Insurance Companies
Employee's Report For Worker's Compensation
To download, right-click on the filename, then choose Save Target As...
This form is in Microsoft Word (R) format.


    Premier Insurance Brokerage, Ltd. 127 N. Walnut St. Itasca IL 60143, P: 630-694-4421
All right 2003 Premier Insurance Brokerage, Ltd. All rights reserved.
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