Get Dwc 11

Filling out the Dwc 11 form is an important step for corporate officers who wish to elect coverage under Rhode Island's workers’ compensation laws. This guide provides clear and user-friendly instructions to help you complete the form accurately.

Follow the steps to successfully complete the Dwc 11 form.

1. Click ‘Get Form’ button to access the Dwc 11 form and open it for editing.
2. Begin by entering your full name in the designated field. Make sure to provide your complete legal name as it appears on your official documents.
3. Next, input your Social Security number accurately. This information is vital for identification purposes.
4. Fill in your current address, ensuring it is up to date. This should be your primary place of residence.
5. Provide your date of birth in the required format. This data is necessary for age verification.
6. Specify your corporate title within the business. Clearly state your position to validate your role as an officer.
7. Enter the name of the business you are associated with. Ensure that it matches official records.
8. If applicable, include the 'Doing Business As' (DBA) name of the business. This is important if your business operates under a different name.
9. Provide the business address, making sure to include street, city, state, and zip code.
10. Fill in the Federal Employer Identification Number (FEIN) of the business. This is crucial for tax identification.
11. Indicate the name of your insurer, as well as your insurance policy number for workers' compensation.
12. Read the declaration statement carefully. You are required to certify the accuracy of the information provided by signing your name in the designated space.
13. The notary public signature and date area must be completed. Seek a notary to validate your signature as required.
14. Be aware that a filing fee of five dollars ($5.00) is necessary for your submission. Include a check or money order made out to the Rhode Island Department of Labor and Training.
15. Retain a copy of the completed form for your records. Send a copy to your insurance company and submit the original to the Department of Labor and Training.
16. For a receipt of your submission, include a self-addressed, stamped envelope with your original form. This will allow you to receive a date-stamped copy.

Complete your Dwc 11 form online today to ensure you are properly covered under workers’ compensation.