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                Get Mn Lic 04 2016-2025
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How to fill out the MN LIC 04 online
Filling out the MN LIC 04 form online is essential for business license applicants in Minnesota to provide proof of compliance with workers' compensation insurance regulations. This guide will walk you through each section of the form to ensure your submission is accurate and complete.
Follow the steps to successfully complete the MN LIC 04 form.
- Click the ‘Get Form’ button to obtain the MN LIC 04 form and access it for online completion.
- Begin by entering your license or certificate number, if applicable, followed by your business telephone number and alternate telephone number.
- Provide the legal name of your business entity in the business name field. If applicable, include owner names for sole proprietorships or partnerships.
- If your business operates under a different name, fill in the DBA (doing business as) field.
- Enter your physical business address, ensuring it is not a P.O. box. This should include street address, city, state, county, email address, and ZIP code.
- Next, you must complete one of the two required options regarding workers' compensation insurance. Indicate if you have a workers' compensation insurance policy, including the insurance company name, policy number, effective date, and expiration date.
- Alternatively, if you are self-insured, you must attach a copy of the authorization from the Minnesota Department of Commerce.
- If you are not required to have workers' compensation insurance, select the applicable reasons listed, such as using only independent contractors or having no employees.
- If applicable, explain the reasons why your employees are not required to be covered by the workers' compensation law.
- After completing all relevant sections, certify that the information provided is accurate by printing your name and providing your signature, title, and date. Ensure you are authorized to sign on behalf of the business if needed.
- Finally, review all entries for accuracy, then you can save changes, download, print, or share the completed MN LIC 04 form.
Complete your MN LIC 04 form online today to ensure compliance with Minnesota workers' compensation regulations.
Filling the LIC claim form in PDF format requires you to download the form from the LIC website. After opening it, enter your details clearly, ensuring that all required fields are completed. Once you have filled in the MN LIC 04 form, save the changes, print if needed, and submit it as per the instructions given to expedite your claim processing.
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