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OhioBWC - Employer - Form:  Application for Permanent Authorization

Permanent Authorization (AC-2)

Introduction

This form allows an employer or employer representative to authorize access to a company's policy and/or claim(s) based on the type of representation requested.
Note: There must be a hard copy of the AC-2 on site at the employer's before you can submit the form here online. This authorization will supersede all permanent authorizations on file for the representative type chosen.


Required information
  • Policy number OR Federal tax ID/SSN
  • Authorized representative ID/Name
  • Authorized representative type
  • Name of person who completed hard copy AC-2
  • Title of person who completed hard copy AC-2
  • Actual date of completed hard copy AC-2

Complete the forms

The free Adobe Reader software is required to display and print the application.

Do you have all the required information at hand? If so, you are ready to begin completing the form. When completing the online form, please use the previous and next buttons located at the bottom of the page to navigate through the form.
Begin online form now.

Are you missing some of the required information? If so, you may return here at a later time when you have all the information you need, and complete this online form.


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