Get Dli Verify Pa Gov

This guide provides comprehensive instructions on filling out the Dli Verify Pa Gov online. Whether you are a business owner or an executive officer, following these steps will help ensure that your application is submitted accurately and efficiently.

Follow the steps to complete your application correctly.

1. Press the ‘Get Form’ button to access the application and open it for editing.
2. Begin by filling out the corporation information section. Provide the federal employer identification number, the full legal name of the corporation, and the corporation's address, including city, state, and ZIP code.
3. Indicate whether the corporation has Pennsylvania employees beyond those listed in the attached declarations by selecting 'Yes' or 'No'. If 'Yes', provide the employer's current workers' compensation coverage details, including the insurance company name and policy number.
4. Next, specify the effective date range for the policy by filling out the policy effective start date and end date using the mm/dd/yyyy format.
5. Select the appropriate corporation type by checking the box next to either Subchapter S, Subchapter C, or Nonprofit.
6. An Executive Officer must verify their authority by signing the form. The officer should write their first and last name, title, and the date of signing. Ensure all statements are true and correct to avoid penalties.
7. Review all entered information for accuracy. Once confirmed, save the changes and download the completed document for your records.
8. Finally, you can print or share the completed application as required for submission to the Bureau of Workers’ Compensation or your insurance carrier.

Take the next step and complete your Dli Verify Pa Gov application online today.