Illinois Workers Compensation Forms

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ILLINOIS WORKERS' COMPENSATION COMMISSION
100 WEST RANDOLPH STREET #8-200
CHICAGO, IL 60601-3227
312-814-6500
APPLICATION FOR IWCC ATTORNEY CODE NUMBER
Attorney Firm Name __________________________________
Address
__________________________________
Suite/P.O. Box
__________________________________
City, State, Zip
__________________________________
E-mail Address
__________________________________
Telephone
__________________________________
Illinois ARDC Registration Number _________________________
RETURN TO: Yvonna Castronova
Public Information Unit
Illinois Workers’ Compensation Commission
100 W. Randolph St. #8-200
Chicago, IL
60601
yvonna.castronova@illinois.gov
Assigned Attorney Code number
_________________________
Date Assigned
_________________________
8/06

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