
Please TYPE or PRINT IN INK 6B-1 Rev. 7-15-2013 State of Connecticut Workers Compensation Commission Date filed with WCC Coverage Election by Employees who are Members of a Partnership DO NOT SEND THIS FORM TO A DISTRICT OFFICE Send to WORKERS COMPENSATION COMMISSION 21 OAK STREET 4th FLOOR HARTFORD CT 06106 IF YOU WISH TO RECEIVE A DATE-STAMPED COPY OF THIS FORM SEND 2 COPIES of each form Pursuant to C.
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How to fill out the Form 6b online
Filling out the Form 6b online can streamline the process of submitting your coverage election for workers' compensation. This guide provides a step-by-step approach to help you complete the form accurately and efficiently.
Follow the steps to complete the Form 6b online.
- Press the 'Get Form' button to obtain the Form 6b and open it in your preferred digital format.
- In the section titled 'Coverage Election', fill in the name of the partnership and its location, including the city or town.
- List all partners' names and provide the complete street address of the partnership. Ensure you accurately input this information.
- Indicate the total number of partners involved in the partnership.
- Choose one of the options regarding your coverage election by marking the appropriate box — either to exclude coverage or revoke a previous exclusion decision.
- Complete the affirmation section by entering the date of signing and providing signatures for each partner along with their respective dates of birth.
- Once all fields are completed, save your changes. You may then download, print, or share the form as needed.
Complete your Form 6b online today for a smoother filing experience.
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