Sign up with SureNotice

Signing up with SureNotice is fast and easy.  The information below will be used to fill out a document entitled “Designation of Insurance Carrier’s Austin Representative” (i.e. DWC-27). After you hit the “submit” button, we will forward to you a completed DWC-27 for final review and signature.  Once executed, we will file it with the Division.

Important: After the filing of the DWC-27, you will continue to receive Division notices from your current Austin Representative for another 30 days.

* Required fields

Type of Entity*

I. Insurance Carrier Information

 

II. Carrier Coordinator

II. Certified Self-Insured Entity Information

 

III. Certified Self-Insured Coordinator

II. Governmental Entity Information

 

III. Governmental Coordinator