Get Workman Comp Waiver Exemption Form For Arkansas

Completing the Workman Comp Waiver Exemption Form For Arkansas online is an essential process for individuals seeking exemption from workers' compensation insurance. This guide provides clear, step-by-step instructions to assist you in successfully filling out the form.

Follow the steps to fill out the Workman Comp Waiver Exemption Form For Arkansas.

1. Click ‘Get Form’ button to access the form and open it in your online editor.
2. Fill in your printed name in the designated field for applicant information. Ensure it matches your official identification.
3. Enter your Social Security number accurately in the provided section.
4. Affix your signature and date the document in the appropriate fields at the bottom of the applicant information section.
5. List all names under which you conduct business in the ‘Company Name’ field.
6. Provide your business address in the designated area, making sure it is your own address, not that of the contracting company.
7. Respond to the employment questions by selecting ‘Yes’ or ‘No’. Ensure that you evaluate whether the business employs others aside from the listed parties.
8. If applicable, provide insurance company details and policy number if you or your employees are covered under any workers’ compensation policy.
9. If any answers to previous questions are ‘Yes’, present the form to your insurance agent for further processing, ensuring they fill in their name, address, and signature.
10. If all answers are ‘No’, submit the completed form to the Coverage/Compliance Section at the Arkansas Workers’ Compensation Commission via mail or in person.
11. After completing your submission, ensure you save changes, and if necessary, download or print a copy for your records.

Complete your documents online now for a smooth submission process.