Get Erm 14 Form Ny

The Erm 14 Form Ny is a confidential request for ownership information necessary for establishing premiums for your insurance coverage. Accurately completing this form is crucial for documenting ownership changes related to your workers' compensation policy.

Follow the steps to efficiently complete the Erm 14 Form Ny online.

1. Click ‘Get Form’ button to obtain the Erm 14 Form Ny and open it in your preferred editing tool.
2. Begin with Section A—Transaction and Entity Information. Enter the effective date of the transaction, along with the report date. Provide details regarding name and entity changes, sales, transfers, or conveyances of ownership interests.
3. Complete the columns for each entity involved in the transaction. For each entity, specify the name, Risk ID, type of entity, and Federal Employer Identification Number (FEIN). Include contact information such as address, telephone number, and email address.
4. Move to Section B—Ownership. Answer the questions regarding the entities' operational names, common majority ownership, and prior business relations. Provide thorough explanations if prompted.
5. In Section C—Additional Information, fill in any pertinent details regarding the transaction that are not covered earlier. If more space is needed, add a supplementary narrative on the entity’s letterhead, signed by an owner or relevant executive.
6. In Section D—Did You Remember to..., ensure all required items are checked. Confirm the types of transactions, entity details, and ownership information have been adequately provided according to the guidelines.
7. Complete Section E—Certification. Sign and date the form, indicating the title the signer holds within the entity.
8. Finally, review the form for completeness before submitting it to the Underwriting Department as directed. Save changes, download or print the completed form as needed.

Start filling out the Erm 14 Form Ny online to ensure your ownership changes are properly documented.