Get Db-212.3 - Workers' Compensation Board

The DB-212.3 form is essential for corporations in New York that wish to exclude certain executive officers from workers' compensation coverage. This guide offers clear instructions to help users complete the form accurately and efficiently online.

Follow the steps to complete the DB-212.3 form online.

1. Click ‘Get Form’ button to access the DB-212.3 form and open it in your preferred online editing tool.
2. Enter the name of your corporation in the 'Corporation Name' field. Ensure the name matches your legal documentation.
3. Select the type of corporation by checking one of the two options: 'One-person corporation' or 'Two-person corporation'. Note the criteria for each type outlined in the instructions.
4. List the executive officer(s) to be excluded from coverage under the section labeled 'Executive Officer(s) to be excluded from policy'. Fill in the name(s) and title(s) correctly.
5. For the one-person corporation, enter your name, title, and date in the certification section. Include your signature and telephone number.
6. If applicable, affix your corporate seal below, or check the box if your corporation does not have a seal.
7. Review all filled fields for accuracy before saving, downloading, or printing the completed form. Ensure all mandatory information is provided.

Complete your DB-212.3 form online today and ensure compliance with the workers' compensation requirements.