WORKERS’ COMPENSATION AGENCY SERVICE COMPANY APPLICATION American LegalNet, Inc. www.FormsWorkFlow.com a resume covering prior experiences must be attached to this application. a resume covering prior experiences must be attached to this application. a resume covering prior experiences must be attached to this application. Attach a copy of the applicant’s most recent annual financial statement (certified financial statements are preferred). Attach a copy of the applicant’s standard service contract. NOTE: IF THE SERVICE COMPANY DEVIATES FROM THIS STANDARD CONTRACT FOR ANY MICHIGAN CLIENT, PRIOR WRITTEN APPROVAL MUST BE RECEIVED FROM THE MICHIGAN WORKERS’ COMPENSATION AGENCY. American LegalNet, Inc. www.FormsWorkFlow.com WORKERS’ COMPENSATION AGENCY R408.43m-EFFECTIVE MARCH 1, 2007 R 408.43m Servicing self-insured employers or groups; application; requirements; noncompliance. American LegalNet, Inc. www.FormsWorkFlow.com