Get Maryland Officer Exclusion Form
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How to fill out the Maryland Officer Exclusion Form online
This guide provides a clear and user-friendly approach to completing the Maryland Officer Exclusion Form online. By following these instructions, users can ensure they accurately fill out the form to indicate their exclusion from workers' compensation coverage as allowed under Maryland law.
Follow the steps to accurately complete the Maryland Officer Exclusion Form online.
- Click ‘Get Form’ button to obtain the Maryland Officer Exclusion Form and open it for editing.
- Identify the date when the company was notified about the intention to file the exclusion. Fill in this date in the designated field.
- Provide the name of the insurance company associated with the corporation in the specific field provided.
- Enter the name of the company where the exclusion is being filed.
- Select the type of company by choosing one of the options: Farm Corporation, Close Corporation, Professional Corporation, or Limited Liability Company.
- Fill in the address of the company, including the city, state, and ZIP code.
- Provide the typed name and title of the officer or member who is electing for exclusion.
- Indicate the percentage of ownership that the officer or member holds in the company.
- Sign the form personally, affirming the accuracy of the information provided.
- Review the completed form for accuracy and completeness before submission.
- Submit the original form to the Workers’ Compensation Commission, send a copy to the company's insurer, and retain a copy for your personal records.
Complete the Maryland Officer Exclusion Form online today to ensure proper coverage management.
To reach the Workers Compensation Commissioner in Maryland, you can visit their official website for contact details. Typically, they provide a phone number and email address for inquiries. Additionally, you can access forms and resources relevant to issues like the Maryland Officer Exclusion Form. This way, you can ensure your questions are directed to the right office.
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