Loading
Get Db-212.3 - Workers' Compensation Board - New York State - Wcb Ny
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the DB-212.3 - Workers' Compensation Board - New York State - Wcb Ny online
The DB-212.3 form is essential for corporations in New York State to elect exclusion from disability benefits coverage for executive officers. This guide provides clear, step-by-step instructions to help users fill out the form accurately and efficiently online.
Follow the steps to complete the DB-212.3 form online effectively.
- Click ‘Get Form’ button to access the DB-212.3 form in your preferred digital format.
- Enter the name of the corporation at the specified field, ensuring that it matches the registered name.
- Provide the address of the corporation in the designated space; this should reflect the official business address.
- Indicate under which laws the corporation is incorporated in the appropriate section.
- Select the type of corporation from the options available: one-person corp. or two-person corp.
- List the names and titles of the executive officers to be excluded from coverage in the specified fields.
- If applicable, complete the certification section by having the appropriate executive officer(s) sign and date the form, including the telephone number.
- If it is a two-person corporation, the signatures of both executive officers are required, along with their respective titles and dates.
- Finally, you can save your changes, download the completed form, print it out, or share it as needed.
Take action and complete your DB-212.3 form online today!
Payment of Benefits Within 18 days of receiving your report of a work-related injury, the insurer should begin paying benefits. However, if the claim is being disputed the insurer must notify your and the New York State Board of Workers' Compensation about why your claim is being disputed.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.