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  • Workers Compensation Or Payroll Based General Liability Phr Form

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Premium Audit P.O. Box 2927 Hartford, CT 061042927POLICYHOLDER AUDIT REPORT Insured Name: Address 1: Address 2: City: State: Zip: Policy Number: (i.e. xxxx1A234567) Policy Term: FAX (800) 8790892.

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How to use or fill out the Workers Compensation Or Payroll Based General Liability PHR Form online

Filling out the Workers Compensation Or Payroll Based General Liability PHR Form online can streamline your reporting process related to your business operations. This guide provides detailed instructions to help you accurately complete each section of the form, ensuring that you provide all necessary information.

Follow the steps to complete the form accurately.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering the policyholder information. Fill in the insured name, address, city, state, zip code, policy number, and policy term accurately.
  3. In the section titled 'Tell us about your business', provide a comprehensive description of your business operations. Include details about work performed, products manufactured, or services provided, as well as any new operations added during the policy term.
  4. Next, complete the company structure section by selecting one of the options: Individual, Partnership, Corporation, or Limited Liability Company. Provide information on the sole proprietor, partner(s), or corporate officer(s), detailing their specific duties, the number of weeks employed during the policy term, and their actual earnings.
  5. Send your supporting documentation as required, including the last four Federal Employer's Quarterly Tax Forms or State Unemployment Wage Reports for all states covered on this policy. If applicable, attach the necessary forms for Sole Proprietors, Partnerships, or Corporations.
  6. Finally, sign the report in the designated area. Fill in your title, email address, phone number, fax number, and date before submitting the form.
  7. Once all fields are completed, review the form for accuracy. You can then save changes, download a copy, print it, or share it as needed.

Start filling out your Workers Compensation Or Payroll Based General Liability PHR Form online today for efficient document management.

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A premium audit is a review of your company's sales and payroll to make sure you paid the appropriate premium for the insurance coverage you needed over the policy period.

Information Needed for an Insurance Audit Description of company operations. Officers'/Owners' names and titles. Employee names and job duties. Number of employees at each location. Names of subcontractors and certificates of insurance for subcontractors.

Payments made by the employer of amounts that would have been legally withheld from employees' pay to meet statutory obligations should be included in the employee's payroll. Such payments include, but are not limited to Social Security, FICA, SUTA, and payments to pension plans.

If you fail to comply with your insurance audit, you will suffer adverse consequences. Carriers can legally charge you up to three times your annual premium for a non-compliant audit. If you don't perform your workers' compensation audit, it will negatively impact your experience modification factor.

Updated January 05, 2023. A Florida notary acknowledgment form is a sworn statement, commonly attached to a legal document, that confirms the authenticity of the person signing.

Policyholder Reports (PHR) Refer to your Online Invitation letter to determine if payroll or sales (or both) are requested and choose from the following: Workers Compensation or Payroll-based General Liability. Sales-based General Liability.

If you have urgent questions regarding your Premium Audit, our Customer Service team is available 8am - 7pm EST Monday - Friday at 800.842. 4271.

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