Mississippi Pool Premium Call 

The Governing Articles of the Mississippi Workers’ Compensation Assigned Risk Pool provide that each member of the Pool shall report to the Pool administrator the workers’ compensation premium written by such member during each calendar year.  Form MS-10 is used for this purpose and must be filed even if no workers' compensation premium was written in Mississippi during the calendar year.

Forms MS-4A and MS-4B are for use by those members claiming credit against their assessment base for employers written out of the Pool on or before 12/31/08.  NCCI will process credits for qualifying policies effective on or after 1/1/09.   (Carriers must enroll with NCCI by February 26^th.  Please refer to NCCI Circular No. PLAN-2009-22 at  www.ncci.com).  

 Form MS-3 should be submitted if your contact information has changed.

To complete the Premium Call and Take-Out Credit forms, right-click on a link below and download the form.  Select “Save Target As” and when a “Save As” window pops up, click on “Save”.  After the “Download Complete” window pops up, click on “Open”, enter the required information on the form and save the file.  Submit the form to CIS using either the email, fax number or address shown on the form. 

For form MS-3, click on the form below, complete the form and print it.  Mail or fax it to CIS at the address or fax number shown on the form.  You may also email the completed form to cisdata@compinsservices.com as an email attachment 

Adobe Acrobat Reader is required to view and print the forms and instructions below.

Forms

Premium Call Form MS-10 

Take-Out Credit Summary Form MS-4A

Take-Out Credit Policy Detail Form MS-4B

Member Company Contact Form MS-3

Instructions 

Annual Premium Call Instructions

Take-Out Credit Instructions

Results 

MS Premium Call Results

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