Get Nd Wsi Insurance Application Form

Filling out the ND WSI Insurance Application Form online is an essential step in obtaining workers' compensation insurance coverage for your business. This guide provides comprehensive and user-friendly instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete your ND WSI Insurance Application Form online.

1. Press the ‘Get Form’ button to access the ND WSI Insurance Application Form and open it in your preferred editor.
2. Begin by entering your general information. This includes the legal name of your entity or individual, the SIC code, and the NAICS code, followed by your trade name if it differs from your legal name.
3. Fill in your federal employer identification number and the date your employee(s) commenced or are expected to commence work in North Dakota.
4. Indicate if you plan to use the services of a Professional Employer Organization or a temporary staffing agency, and provide the required details if applicable.
5. Complete the mailing and business address sections, ensuring that the addresses are accurate and updated. If your mailing address differs from your business address, make sure to specify this.
6. Specify the reason for applying for insurance coverage, indicating whether it is for a new or existing business or a change of entity.
7. Select the appropriate type of entity that best describes your business from the provided options.
8. Choose the principal activity that your business engages in from the extensive list, ensuring that only one selection is made.
9. Fill out the information related to the owners, partners, or corporate officers of your business, indicating their names, titles, addresses, phone numbers, and ownership percentages.
10. Outline any optional coverage desired for owners, partners, or corporate officers, and provide details for any spouse or children under age 22 who may require coverage.
11. Detail the employee activity and estimated 12-month payroll by describing the unique types of work performed and estimating payroll expenditures for each type.
12. Answer questions regarding extraterritorial coverage for any employees who may travel outside North Dakota for work.
13. Acknowledge and sign the fraud warning statement confirming the accuracy of the information provided, and include your printed name, date, and title.
14. Once all sections are completed, save your changes, and you will have the option to download, print, or share the form as necessary.

Ensure you fill out your ND WSI Insurance Application Form online today and secure your workers' compensation coverage.