Form 147 "Workers' Compensation Group Security Deposit Held Under Safekeeping" - Kentucky

What Is Form 147?

This is a legal form that was released by the Kentucky Department of Insurance - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the Kentucky Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 147 by clicking the link below or browse more documents and templates provided by the Kentucky Department of Insurance.

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Download Form 147 "Workers' Compensation Group Security Deposit Held Under Safekeeping" - Kentucky

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Commonwealth of Kentucky  Department of Insurance  500 Mero Street P.O. Box 517 Frankfort, KY 40602
Phone: 502-564-6082  FAX 502-564-4604
Kentucky Department Of Insurance
Workers' Compensation Group Security Deposit Held Under Safekeeping
I have satisfied this requirement with a bank letter of credit. Attached SI-04 and letter of credit
I have satisfied this requirement with a deposit. See calculation below.
Check the correct box and provide the calculation.
Calculate the greater of the premium or reserves, with a minimum of $250,000.
$250,000
Premium
=
10%
=
Deposit
=
Reserves
=
10%
=
Deposit needed
=
Name of Fund
__________________________________
Name of Preparer
__________________________________
Signature of Preparer
__________________________________
Date Prepared
__________________________________
Form 147 Updated 6/2020
Commonwealth of Kentucky  Department of Insurance  500 Mero Street P.O. Box 517 Frankfort, KY 40602
Phone: 502-564-6082  FAX 502-564-4604
Kentucky Department Of Insurance
Workers' Compensation Group Security Deposit Held Under Safekeeping
I have satisfied this requirement with a bank letter of credit. Attached SI-04 and letter of credit
I have satisfied this requirement with a deposit. See calculation below.
Check the correct box and provide the calculation.
Calculate the greater of the premium or reserves, with a minimum of $250,000.
$250,000
Premium
=
10%
=
Deposit
=
Reserves
=
10%
=
Deposit needed
=
Name of Fund
__________________________________
Name of Preparer
__________________________________
Signature of Preparer
__________________________________
Date Prepared
__________________________________
Form 147 Updated 6/2020