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Get Work Comp Rejection Forms - Centerpoint Insurance Group
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How to fill out the Work Comp Rejection Forms - CenterPoint Insurance Group online
Completing the Work Comp Rejection Forms for CenterPoint Insurance Group can be straightforward with the right guidance. This guide will provide you with clear, step-by-step instructions to ensure that your form is filled out correctly and efficiently.
Follow the steps to successfully complete the Work Comp Rejection Forms online.
- Press the ‘Get Form’ button to access the form and open it in the editing interface.
- Identify the type of entity by checking the appropriate box indicating whether it is a corporation or a limited liability company (LLC).
- Enter the legal name of the corporation or LLC as registered with the Secretary of State.
- Provide the complete mailing address of the corporation or LLC, including street or P.O. Box, unit/suite, city, state, and zip code.
- Input the Federal Employer Identification Number assigned to the entity by the IRS.
- List the business phone number for the Corporate Secretary or LLC Manager who is signing the form.
- Enter the date of incorporation or the date of filing of the Articles of Organization and ensure to attach the required documents issued by the Secretary of State.
- Describe the nature of the business conducted by the corporation or LLC.
- List the names, titles, and percent of ownership or membership interest for each corporate officer or LLC member rejecting coverage.
- Specify the number of employees, excluding those listed in the previous step, within the corporation or LLC.
- Fill in the workers’ compensation policy information, including insurer name, policy number, and effective dates.
- Provide the name, title, and signature of the Corporate Secretary or LLC Manager to certify that the information is accurate and complete.
- Complete Part B by listing the name of the corporation or LLC, and repeating the information for each corporate officer or LLC member who is rejecting coverage.
- Sign and date the declaration indicating the rejection of workers' compensation insurance coverage and have the signature notarized.
- File the completed form by certified mail to the insurance carrier or the Division of Workers’ Compensation as directed.
Complete your Work Comp Rejection Forms online today for a smooth filing process.
IA Code. Sole proprietors, partners in a partnership, and members of a limited liability company have a status other than of an employee and are not covered by Iowa workers' compensation law. They may, however, elect to be covered by purchasing insurance that expressly covers them.
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