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Get Mn Lic 04 2012
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How to fill out the MN LIC 04 online
The MN LIC 04 form is essential for demonstrating compliance with Minnesota's workers' compensation insurance laws. This guide will walk you through each section of the form, ensuring you provide accurate information for a smooth filing process.
Follow the steps to complete the MN LIC 04 online.
- Press the ‘Get Form’ button to access the MN LIC 04 online form and open it for editing.
- Fill in your business details, including the license or certificate number, business telephone number, fax number, and business name. If you are a sole proprietor or partnership, include the names of the individuals involved.
- Enter your business address. Make sure to provide a physical street address, as P.O. boxes are not accepted. Include the city, county, state, and ZIP code.
- Provide your email address for future correspondence regarding your application.
- Choose either number 1 or number 2 regarding your workers' compensation insurance: For number 1, input the required insurance policy information such as the insurance company name, policy number, NAIC number, effective date, and expiration date.
- If you are claiming an exemption under number 2, specify your reason for exemption. Options include having no employees or being self-insured. Provide any necessary explanations as required.
- Complete the certification section by signing the form. If signing on behalf of a business, ensure you state your title and the date.
- Review all entries to confirm accuracy. Once satisfied, save the changes, and opt to download, print, or share the completed form as needed.
Complete your MN LIC 04 form online today to ensure compliance with Minnesota's workers' compensation laws.
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Filling a LIC assignment form starts with accessing the official document online. Enter all requested information clearly, including policy details and personal identification. Review the form to ensure all information is accurate and complete before submitting it. For templates and assistance regarding MN LIC 04, visit US Legal Forms to make the process simpler.
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