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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.

Members may claim credit against their assessment base for employers written out of the Pool.  The Take-Out Credit Program continues in effect for the Mississippi Pool.  To receive credits, you must be enrolled with NCCI.

ONLINE SUBMISSION of FORM MS-10 is required.  Please do not mail, email, or fax a copy of your submission.  If your contact information has changed, FORM MS-3 should also be submitted.

All necessary forms and instructions are provided below.   If you have any questions, please call 601-977-9456.

Please note that Adobe Reader is required to view and print the instructions.  If you do not already have Adobe Reader installed, please click on the icon below:  

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Premium Call

Click the link below for detailed instructions on how to complete the Online FORM MS-10.

Annual Premium Call Instructions

Click the link below to complete your submission online.  Once the online FORM MS-10 appears, complete the appropriate fields.  Attach Statutory Page 14 (in PDF format) with your online submission, by clicking the "Choose File" button located in the "Statutory Page 14" section.  If you would like a copy of your online submission, please Print it before clicking the "Submit Form" button.

Online Submission: FORM MS-10


Member Company Contact

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

Use the link below to download FORM MS-3 and open the document.  Use "Save As" to save a copy of the form as a Microsoft Word document to the appropriate location on your computer.  Fill in the applicable information using the Tab key or arrow keys to move from field to field. 

"Save" your changes and email the completed form to:

Email Submission: FORM MS-3



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