Get Cancellation Of Form K-wc 113 - Dol Ks

Filling out the CANCELLATION OF FORM K-WC 113 - Dol Ks is an essential step for individuals or businesses seeking to cancel their previous election under the Kansas Workers Compensation Act. This guide will provide clear, step-by-step instructions to efficiently complete the form online.

Follow the steps to complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in an online editor.
2. Begin filling in the 'Individual cancelling election' section by entering the full name of the person who is cancelling their previous election.
3. Provide the Social Security number in the designated field, ensuring it is accurate for identification purposes.
4. Enter the email address of the individual in the next field to facilitate communication.
5. Complete the address section by providing the full address of the individual cancelling the election.
6. If applicable, include the name of the business (DBA) associated with the individual.
7. Write a statement indicating that the individual hereby cancels their previous election to be covered under the provisions of the Kansas Workers Compensation Act.
8. The individual must sign the form in the signature area to confirm the cancellation.
9. Ensure that the insurance carrier or group funded pool administrator completes their section of the form. This is crucial for validation; note that it cannot be signed by an insurance agent.
10. Fill in the name of the insurance carrier or group funded pool, and state that the individual is no longer insured, followed by the effective date of the coverage cessation.
11. The representative of the insurance carrier must sign and include their title and address to complete this section.
12. Once all fields have been completed, review the form for any errors or omissions, then save your changes.
13. Finally, download, print, or share the completed form as necessary.

Complete your documents online to ensure your cancellation is processed promptly.