Get Affidavit Of Exempt Status Under The Workers Compensation Code

This guide provides clear, step-by-step instructions for completing the Affidavit of Exempt Status Under the Workers Compensation Code online. Designed for users with varying levels of experience, this resource will help you navigate the form effectively.

Follow the steps to complete the affidavit accurately.

1. To access the form, click the ‘Get Form’ button to open it in your document editor.
2. Begin by filling in the state and county where the affidavit is being executed. Ensure that the details reflect your current situation.
3. In the first blank, write your full name. This represents the individual stating the oath.
4. Proceed to list the numbered points (1-9) that pertain to your independent contractor status, providing the necessary details where applicable.
5. In the subsequent section, enter your name again, along with your business name. This identifies you as the independent contractor.
6. Specify the contractor's name you have agreed to provide services for during the calendar year being referenced in the form.
7. Indicate that you have read, signed, and attached the Exempt Status Fact Sheet, ensuring that you understand your independent contractor status.
8. Affirm your understanding that you are not considered an employee under the Workers Compensation Code and that you do not want workers compensation insurance.
9. Confirm that you will obtain necessary insurance for any employees you might have.
10. Complete the last sections, including the date, your signature as the independent contractor, and the title of your position.
11. The notary public section must be filled out where the affidavit will be executed, signed, and notarized.
12. Finally, after completing and notarizing the form, save changes, and if required, download, print, or share the form.

Take action today by completing your documents online for a smoother filing process.