Get Ny Ue-4m 2013-2026

Filling out the NY UE-4m form is an essential step for businesses seeking workers' compensation and employers' liability insurance in New York State. This guide provides a clear and comprehensive approach to completing the form online, ensuring you meet all necessary requirements.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering the requested effective date of insurance. Ensure to input the date in the format MM/DD/YYYY, along with the time specified.
3. Input the full name of the employer, including any trade names or doing business as names. If you have more than one employer to include, attach additional sheets as necessary.
4. Provide the main New York State work location of the employer. Ensure not to use a P.O. Box and include the full physical address, city, state, zip code, and relevant contact information.
5. Indicate if you have a representative and, if so, complete the representative's details including their name, contact number, and address.
6. Specify how long your company has been in business by entering the total number of years and months.
7. Answer whether you have been insured for workers' compensation previously. If you answer ‘yes,’ provide details about your workers' compensation experience for the past five years.
8. If applicable, enter your rating board file number, experience modification factor, and effective rating date.
9. Indicate if you have been declined for coverage in the past 12 months and provide the name of the insurance company and reason for the decline if you answer ‘yes.’
10. Describe your business operations thoroughly, detailing products or services provided.
11. List your estimated annual payroll by type of work or duties for your employees. Indicate if you wish to exclude any executive officers, partners, or members from coverage.
12. If applicable, indicate the state of incorporation and date of incorporation for your business.
13. If you have multiple business locations, list all locations to be covered in New York State.
14. Provide additional information on all employers seeking coverage as listed in earlier steps.
15. Enter the name and address of your bank for reference.
16. Provide contact information for the person responsible for a premium audit.
17. List information for the sole proprietor, executive officers, or partners as necessary.
18. Provide details regarding your disability benefits insurance, and indicate whether you would like a quote.
19. Provide any information regarding your general liability insurance.
20. Finally, sign the form and include the date, ensuring all required documentation is attached before submission.

Complete your NY UE-4m application online today to ensure you meet all necessary insurance requirements.