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Workers compensation application

Questions? Call +1.800.995.1012
Monday – Friday, 8:30 a.m. – 5:00 p.m. EST

Please note: There is no option to save the form, so please have all information ready when you begin.

Fields with an asterisk (*) are required.

Please note that Markel can send most insurance documents by email. Please provide a valid email address if you wish to receive your documents electronically.


Location 1 (if different from mailing address above)
Location 2
Location 3
Location 4
Location 5

Individuals included/excluded

Rating information

Prior carrier information/loss history (Need if submitting new business ONLY)

General information

If yes, payroll for this work must be included in the rating information