Get Ny C-105.2 2007-2025

The NY C-105.2 form is essential for providing proof of workers' compensation insurance coverage in New York State. This guide will walk you through the online process of completing this form, ensuring that all required information is accurately included.

Follow the steps to complete the NY C-105.2 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In section 1a, enter the legal name and street address of the insured. Ensure that only the street address is provided, without including any additional details.
3. Provide the business telephone number of the insured in section 1b. This number will be used for any necessary follow-up.
4. In section 1c, input the NYS unemployment insurance employer registration number of the insured. This helps verify the business's compliance with unemployment insurance laws.
5. If the coverage is limited to specific locations, complete the work location of the insured in section 1d. Otherwise, you can skip this field.
6. In section 2, fill out the name and address of the entity requesting proof of coverage. This is the entity that will be listed as the certificate holder.
7. Next, provide the federal employer identification number or social security number of the insured in section 1d, as required.
8. For sections 3a and 3b, enter the name of the insurance carrier and the policy number associated with the insured, as listed in box 1a.
9. Complete section 3c by specifying the policy effective period. This should reflect both the start and end date of the coverage.
10. In section 3d, indicate whether the proprietor, partners, or executive officers are included in the coverage by checking the appropriate box.
11. Review all the entered information for accuracy. Once verified, you can save your changes, download, print, or share the form as needed.

Complete the NY C-105.2 online today to ensure compliance with workers' compensation insurance requirements.