Get Pa Workers Compensation Affidavit Of Exemption - Silver Spring Township 2022-2025
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How to fill out the PA Workers Compensation Affidavit Of Exemption - Silver Spring Township online
This guide provides clear and detailed instructions for completing the PA Workers Compensation Affidavit Of Exemption for Silver Spring Township online. By following these steps, users can ensure their form is filled out correctly and submitted efficiently.
Follow the steps to complete the affidavit accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editing interface.
- Begin by entering the 'Company Name' in the designated field. This should reflect the legal name of the entity or individual responsible for the work.
- Select the appropriate reason for exemption by marking one of the checkboxes provided. The options include: 'Property owner performing own work', 'Contractor has no employees', or 'Religious exemption under the Workers’ Compensation Law'.
- If you select 'Property owner performing own work', be aware that if you hire a contractor, they must provide proof of workers' compensation insurance to the municipality.
- For 'Contractor has no employees', note that the contractor must comply with legal requirements regarding employment and insurance.
- If you choose 'Religious exemption under the Workers’ Compensation Law', ensure to attach copies of the religious exemption letter for all employees.
- Sign the form in the designated 'Contractor Signature' field. Also, print your name in the 'Contractor Name' section exactly as you signed it.
- Provide your residential address in the 'Contractor Resides in' field, including county and township information.
- Next, prepare for notarization. The form must be subscribed, sworn to, and acknowledged before a notary public. Ensure to leave spaces for 'Day' and 'Year' of notarization.
- Finally, review the entire form for accuracy. Once you have filled out the form, you may save changes, download, print, or share the document as needed.
Begin filling out your PA Workers Compensation Affidavit Of Exemption online today.
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Fill PA Workers Compensation Affidavit Of Exemption - Silver Spring Township
Affidavit of Exemption (Workers Compensation). The document is a Workers' Compensation Affidavit of Exemption for Silver Spring Township, Pennsylvania. C. EXEMPTION (Complete this section if applicant is a contractor claiming exemption from providing Workers' Compensation Insurance). All employees of contractor are exempt from workers compensation insurance. (attach copies of religious exemption letter for all employees). I am, therefore, knowingly and voluntarily waiving my rights to any benefits under the Pennsylvania Workers' Compensation Act. I understand that if I am a contractor requesting an exemption under the Workers' Compensation Act that I must sign this form in front of a notary public. Compensation Insurance. Originally adopted as Ordinance No. 95-10 on October 11, 1995. Amended August 11, 1999 (Ordinance No. 99-6).
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