Get Notification Of Ownership Change Or Combinability Of Entities

Filling out the Notification of Ownership Change or Combinability of Entities form is essential for conveying accurate ownership information to the California Workers’ Compensation Insurance Rating Bureau. This guide provides a step-by-step approach to completing the form online, ensuring your submission is clear and compliant.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to access the Notification of Ownership Change or Combinability of Entities form and open it in your online editor.
2. In Part I, enter the contact information of the party submitting the form. Ensure to include the name, title, date, company, mailing address, and contact details.
3. Proceed to Part II to fill in the optional employer/policyholder contact information. This part is not mandatory but can be helpful.
4. In Part III, select the appropriate reason for submitting the form. Choose between 'Entity changed ownership' or 'Entities should be combined or separated.' Follow the instructions accordingly.
5. Move on to Part IV if there is a change in ownership. Provide a brief narrative explaining the nature of the ownership change, the date of the change, and any relevant details about familial relationships involved. Complete all required fields as specified.
6. Fill in the required details for each entity that underwent a change in ownership. Include the legal names, addresses, ownership types, insurer information, and any other necessary identifiers.
7. If applicable, continue to Part V to explain the combinability of entities. Provide a brief narrative on why the entities should be combined or separated and include required details for each entity involved.
8. Once all sections are filled out, review all information for accuracy. Make any necessary modifications to ensure completeness.
9. After reviewing, save your changes. You can download, print, or share the completed form as needed. Ensure someone authorized signs the form before submission.

Complete the Notification of Ownership Change or Combinability of Entities form online to ensure prompt processing of your ownership change.