Get K-wc 113 (rev

Filling out the K-WC 113 (Rev) form is an important step for individuals electing to come under the Kansas Workers Compensation Act. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the K-WC 113 (Rev) form.

1. Press the 'Get Form' button to access the document and open it in your preferred editor.
2. Begin by filling out the 'Name of individual to be covered under Act' field with the full legal name of the person electing for coverage.
3. Enter the Social Security number in the designated field. Ensure that this number is accurate, as it is a requirement for processing.
4. Fill in the 'Email' address to facilitate communication regarding the application.
5. Provide the 'Address of business,' including street address, city, state, and zip code.
6. In the 'Name of business (DBA)' section, enter the trade name that the business operates under, followed by the Federal Employer Identification Number (FEIN).
7. Read and understand that by checking the relevant box, you are electing to cover yourself as an individual under the Kansas Workers Compensation Act.
8. Sign in the space provided to confirm that all information is correct and that you are making this election under the law.
9. It is essential to have the representative from the insurance carrier or group-funded pool complete the lower section of the form. This section must be filled out and cannot be done by an agent.
10. Ensure that the insurance carrier signs and dates the coverage portion accurately, including the first date of coverage.
11. Review all sections for accuracy and completeness. Save the completed form, then download or print a copy for your records.
12. Share the completed form with necessary parties as required.

Complete your K-WC 113 (Rev) form online today and ensure your coverage under the Kansas Workers Compensation Act.