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Application for Registration

Please fill out the fields in the form below to apply for FREE First Report of Injury Inquiry (FROI) access to the MWCC WEBSITE. We ask that each individual in your organization register for their own unique login and password with us.

The MWCC requires a valid business need  for (FROI) access privileges and reserves the right to not approve your application. In any case you will be notified by email of the status of your application. This process may require up to three business days.

A list of acceptable business needs for you to select from is provided below. The information you provide will be cross checked with the MWCC Workers' Compensation Information System (WCIS) for validation. Please provide a brief description of your business need.

Business Need  
Description
Company (Optional for Claimant)
Attorney Bar # (if Attorney)
FEIN/SSN (no dashes) - Please fill with 999999999 if you do not wish to submit your FEIN/SSN.
Address
(optional)
(optional)
City
State/Province
Zip/Postal Code
Phone (area code + number, no dashes)
Email
First Name
Last Name
Title
Fax number (optional, area code + number , no dashes)
USER AGREEMENT: As a registered user of this service provided by The Mississippi Workers' Compensation Commission, I agree to access and review the information available herein only for legitimate and lawful purposes, and I further agree not to make any fradulent use or disclosure of the information obtained herin, or to in any way use or disclose this information in a manner or for a purpose inconsistent with law.
Agree ? (You must enter YES to accept the user agreement above)
(Please choose a unique password of NO MORE THAN 8 (eight) alphanumeric characters. Any characters beyond 8 will be truncated.
Password
VerifyPassword

 

 




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