Get Owner/officer Exclusion Form - Stonetrust Commercial Insurance

Completing the Owner/officer Exclusion Form for Stonetrust Commercial Insurance is an essential step for sole proprietors, partners, and corporate employees wishing to exclude themselves from workers' compensation coverage. This guide will provide you with clear and detailed instructions on how to successfully fill out the form online.

Follow the steps to complete and submit the form online.

1. Press the ‘Get Form’ button to access the Owner/officer Exclusion Form and open it in your preferred online viewer.
2. In the first section, enter the name of the named insured. This is typically the business entity requesting the exclusion.
3. Next, input the policy number if a policy has been issued. This will help to link your exclusion request to the correct insurance coverage.
4. Indicate your status as a sole proprietor, partner, or corporate employee by checking the appropriate box.
5. In the section that states 'I attest that:', specify the business name or corporation you are affiliated with where you own fifteen percent (15%) or more of its stock.
6. Sign the form where indicated to formally elect to reject coverage under the Workers' Compensation Act.
7. Fill in the date of signing and provide your social security number for identification purposes.
8. Indicate your percentage of ownership in the corporation or partnership.
9. Print your name and title under your signature to clarify your position within the business.
10. If there are multiple participants requiring exclusion, repeat steps 5 to 9 for each individual. If necessary, use additional forms.
11. Once all information has been entered, review the form for accuracy and completeness. Then, save your changes and prepare to submit.
12. Download and print the completed form for your records, or share it with any necessary parties as needed.

Don't hesitate to start filling out your Owner/officer Exclusion Form online now!