This report is for Insurance Carriers to report their annual premiums and assessments to the Commission for tax assessment purposes.
The Insurance Carrier will complete the form, have it notarized and return the original copy to the Commission on or before January 31st.
This form may be filed with the Commission in the following ways:
- MAIL: Mail the completed form to 333 E. Franklin St., Richmond, VA 23219.
- IN PERSON: Bring the completed form to any of our VWC Office Locations.
For questions about or assistance with completing this form, please contact Amy M. Pearson, Assistant Financial Officer, at 804-482-7042 or by email at email@example.com.