Get Libc 14b

The Libc 14b form is essential for individuals who wish to waive their rights to worker's compensation benefits based on their religious beliefs. This guide outlines the steps to fill out the Libc 14b form online, ensuring users can navigate the process with ease and confidence.

Follow the steps to fill out the Libc 14b form correctly.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by filling in your name in the EMPLOYE field, followed by your street address, city or town, state, and ZIP code in the designated areas. Ensure all information is accurate.
3. Next, provide your employer's name and their street address, city or town, state, and ZIP code in the respective fields.
4. Enter your social security number in the EMPLOYE SOCIAL SECURITY NUMBER section to verify your identity.
5. In the WAIVER OF WORKERS’ COMPENSATION AND AFFIDAVIT section, write your name and the name of your religious sect or division where prompted. Clearly state your adherence to the tenets that oppose acceptance of any public or private insurance benefits.
6. Complete the statement affirming your waiver of rights to benefits under the Pennsylvania Workers’ Compensation Act. Make sure to sign and date where indicated.
7. If applicable, a parent or guardian may need to sign the form in the case of a minor being the empolyee.
8. The next section requires the signature of the religious sect leader. They must also provide their title and the date of signing.
9. Finally, review all entered information for accuracy. You can then choose to save changes, download, or print the form for submission.

Complete your Libc 14b form online today to ensure your rights and beliefs are respected.