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Form C-59 (BWC-1177) Self-insurers' Agreement as to Compensation on Account of Death - Ohio
What Is Form C-59 (BWC-1177)?
This is a legal form that was released by the Ohio Bureau of Workers' Compensation - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form C-59?
A: Form C-59 is the Self-insurers' Agreement as to Compensation on Account of Death in Ohio.
Q: What is BWC-1177?
A: BWC-1177 is the form number assigned to Form C-59.
Q: Who is required to fill out Form C-59?
A: This form is to be completed by self-insured employers in Ohio.
Q: What is the purpose of Form C-59?
A: Form C-59 is used to report compensation on account of death related to work-related injuries or illnesses.
Form Details:
- Released on March 1, 2005;
- The latest edition provided by the Ohio Bureau of Workers' Compensation;
- 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 C-59 (BWC-1177) by clicking the link below or browse more documents and templates provided by the Ohio Bureau of Workers' Compensation.
