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INSTRUCTIONS This form shall be submitted annually by companies operating any disposal wells, storage wells, or enhanced recovery projects within the state of UtahUHJDUGOHVVRIZKHWKHUWKHZHOOVDUHXQGHU6WDWHRU ($3

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How to fill out uic form 4

01

Download UIC Form 4 from the official website of the Universal Insurance Company.

02

Fill in your personal details such as name, address, contact information, and policy number.

03

Provide details of the incident or claim for which you are filing the form, including date, time, and location.

04

Attach any relevant documents such as police reports, medical records, or photographs as evidence.

05

Sign and date the form before submitting it to the insurance company for processing.

Who needs uic form 4?

01

Individuals who have experienced an incident covered by their insurance policy and need to file a claim.

02

Policyholders who wish to request reimbursement for damages or losses as per their insurance coverage.

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What is UIC Form 4?

UIC Form 4 is a form used for reporting underground injection control activities, particularly related to the injection of fluids into underground wells.

Who is required to file UIC Form 4?

Operators of underground injection wells are required to file UIC Form 4 to ensure compliance with federal and state regulations.

How to fill out UIC Form 4?

To fill out UIC Form 4, follow the provided instructions, ensuring to include all required information about the injection well, including its location and operational details.

What is the purpose of UIC Form 4?

The purpose of UIC Form 4 is to assess and monitor the injection activities to prevent contamination of underground sources of drinking water.

What information must be reported on UIC Form 4?

UIC Form 4 must report information such as well identification, type of fluid being injected, depth of injection, and operational data.

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