Get Workers Compensation Verification Form - Lower Macungie Township

Filling out the Workers Compensation Verification Form is essential for contractors seeking to verify their workers compensation status in Lower Macungie Township. This guide provides clear, step-by-step instructions to help users complete the form accurately online.

Follow the steps to complete the form seamlessly.

1. Press the ‘Get Form’ button to obtain the Workers Compensation Verification Form and open it in your preferred editor.
2. In Section A, indicate if you are a contractor within the meaning of the Pennsylvania Workers Compensation Law by selecting ‘Yes’ or ‘No’. If you select ‘Yes’, you must proceed to complete Sections B and C as applicable.
3. In Section B, provide the necessary insurance information. Start by entering the name of the Applicant and their Federal or State Employer Identification Number. If applicable, indicate that the Applicant is a qualified self-insurer for Workers Compensation. Then, fill in the name of the Workers Compensation insurer, the insurance policy number, and the policy expiration date.
4. Move to Section C only if the Applicant is claiming an exemption from providing Workers Compensation Insurance. Indicate the reason for the exemption by selecting one of the options provided, such as being a contractor with no employees or having a religious exemption under the Workers Compensation Law.
5. Next, complete the applicant identification section by printing the Applicant's name clearly, entering the address, city, state, and zip code. Ensure to include the county and municipality information.
6. Finally, the applicant must provide their signature and date the document. It is also necessary to have a notary public sign and seal the form, ensuring that the commission expiration is filled in correctly.
7. After completing all sections, users can save changes, download the filled form, print it for submission, or share it as needed.

Complete your Workers Compensation Verification Form online easily and efficiently.