information or if the handwriting is not legible, it may cause a delay in the issuance of your exemption. SECTION 1: Applicant Name (please print): Applicant’s social security number: / / Applicant’s E-mail address (optional): ______________________________________________________ SECTION 2: I am applying for exemption as a (You must check only one box in this section): CONSTRUCTION INDUSTRY ($50 FEE REQUIRED) Officer of a Corporation (Title): __ -OR- Member of a Limited Liability Com.

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How to fill out the FL DWC 250 online

Filling out the FL DWC 250 form, also known as the Notice of Election to be Exempt, is an important step for applicants seeking exemption from workers' compensation coverage in Florida. This guide will provide clear and structured instructions on how to complete the form accurately online.

Follow the steps to successfully complete the FL DWC 250 online.

  1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online document editor.
  2. In Section 1, print your name, social security number, and optional email address clearly in the designated fields.
  3. Move to Section 2 and select your application type by checking only one box that corresponds to your industry: either 'Construction Industry' or 'Non-Construction Industry' and provide the necessary title if applicable.
  4. In Section 3, make sure your corporation or LLC is registered with the Florida Division of Corporations. Include the document number indicated on your Annual Report.
  5. Proceed to Section 4 to enter the name of your Corporation or LLC, its Federal Employer Identification Number (FEIN), business name, contact phone number, address, and the scope of business or trade.
  6. In Section 5, list all relevant licenses held by either you or the qualifier for your corporation or LLC as per Chapter 489, F.S.
  7. If you completed an electronic payment for this application, input the transaction confirmation number in Section 6.
  8. Section 7 requires you to disclose any affiliations with other corporations or LLCs. Indicate 'Yes' or 'No' and provide details if applicable.
  9. Section 8 demands proof of ownership in the corporation or LLC if you are applying in the construction industry. Adhere to the specified requirements for documentation.
  10. Review Section 9 which includes a fraud notice. At the end of the form, the applicant must sign to attest to the accuracy of the information provided.
  11. In Section 10, identify the workers’ compensation insurance carrier for any non-exempt employees of your business.
  12. Once all sections are completed, ensure all information is correct before saving your changes, downloading, printing, or sharing the completed form.

Complete your FL DWC 250 form online to ensure your application is processed smoothly.

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FL DWC 250 Form

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