Form WC-131 Instructions

Individual Self Insured Employer Information Sheet: is to be fully completed including e-mail addresses and any fictitious (d/b/a) names registered with the Missouri Secretary of State. Please note that the primary contact shown should be the person responsible for maintaining the employer’s Missouri self-insurance authority.

*Please note that the highlighted areas on the forms are areas that MUST be completed.

WC-131 Page 1 Instructions

WC-131 Page 2 Instructions

WC-131 Page 3 Instructions