Mo wc65b 2026

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Click ‘Get Form’ to open the mo wc65b in the editor.
Begin by entering your Business Name and Business Location in the designated fields at the top of the form.
Fill in your Name and Address accurately, ensuring all details are correct for processing.
Choose between Form A (Workers’ Compensation - Exemption) or Form B (Certificate of Insurer) based on your situation. Complete only one form as instructed.
For Form A, provide your Employer Fed ID, Social Security Number, and Account ID. Select a reason for withdrawal from the options provided.
If using Form B, fill in similar identification details and certify your workers' compensation status by providing policy information and carrier details.
Review all entries for accuracy before signing and dating the form at the bottom.

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