Get Form Pe60109 1102

Filling out the Form Pe60109 1102 online is essential for conveying ownership information to the Workers’ Compensation Insurance Rating Bureau of California. This guide will provide you with clear, step-by-step instructions to ensure that your form is completed accurately and efficiently.

Follow the steps to complete the form online with ease.

1. Press the ‘Get Form’ button to acquire the form and open it for your review.
2. Complete Part A, Section I by providing the contact information of the party submitting the form. Include the name, title, mailing address, phone number, fax number, and email address of the individual or entity submitting the form.
3. If applicable, proceed to Section II of Part A to provide optional contact information for the employer or policyholder.
4. In Section III of Part A, check the appropriate box indicating the reason for submitting the form, whether there has been a change in ownership or if entities should be combined or separated for experience rating purposes.
5. If you checked that entities should be combined or separated, complete Part C. Additionally, if you indicated a change in ownership, complete Part B to provide a narrative explaining the nature of the ownership change and fill out all required details concerning the entities involved.
6. Ensure all required fields are filled out completely, as incomplete information may delay processing.
7. Review the entire form for accuracy before proceeding to sign it. Keep in mind that the form requires a signature from an authorized individual.
8. Once completed, save the form. You can then download, print, or share it as needed for your submission.

Complete your documents online today to ensure timely processing.