Get Ss 4523 Form

Filling out the Ss 4523 Form for workers' compensation exemption registration can be a straightforward process when approached methodically. This guide will provide you with the necessary steps to complete the form accurately and efficiently online.

Follow the steps to fill out the Ss 4523 Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the designated online tool.
2. Enter your applicant information. Include your full legal name, date of birth, the last four digits of your Social Security Number, phone number, and email address.
3. Provide your physical address, including the street address, city, state, and zip code. If you are using a business address, ensure it is the principal address of your business.
4. If your mailing address differs from your physical address, enter it in the same format, or state 'same as physical address' if applicable.
5. Select your qualification by checking one of the options provided that reflects your role in the business and eligibility for the exemption.
6. Fill in the initial business entity details, including the business entity name and the Secretary of State Control number. If you are a sole proprietor, enter 'not required' for the Control number.
7. Enter the Federal Employer Identification Number for your business. If you do not have one, please obtain it beforehand.
8. Answer the initial state board for licensing contractors question by checking the appropriate box and providing any required license details.
9. Complete the local business license information by entering the county and city licenses along with their expiration dates if applicable.
10. Check the boxes in the attestation section to confirm your eligibility and understand your rights regarding the workers' compensation exemption.
11. Finally, electronically sign and date the form. Ensure that all sections have been accurately filled out to avoid rejection.
12. After finishing, you can save changes, download the completed form, print it, or share it as needed.

Complete the Ss 4523 Form online today to ensure your workers' compensation exemption registration is processed smoothly.