
Me doing business as) Business Address City Type of Business Business Telephone Number State Zip Code Federal Identification Number Contractor s Board License Number Name of Principal Owner (Please Print) Principal Owner s Telephone Number Principal Owner s Address City State Zip Code Identified as: (Complete one section only) That the above identified business has obtained industrial workers compensation insurance as required by Chapter 616A to D, inclusive, of the Nevada.
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How to fill out the NV DIR Form D-25 online
Filling out the NV DIR Form D-25 is a crucial step for businesses in Nevada to comply with mandatory industrial insurance requirements. This guide will walk you through each section of the form, ensuring that you complete it accurately and efficiently.
Follow the steps to successfully complete the form online
- Press the ‘Get Form’ button to access the NV DIR Form D-25 and open it for editing.
- Begin by entering the business name, including any other names under which the business operates. Then provide the business address along with the city, state, and zip code.
- Fill in the type of business and business telephone number. Ensure you have the federal identification number and, if applicable, the contractor’s board license number ready.
- Next, input the name of the principal owner of the business, followed by their telephone number and residential address, including city, state, and zip code.
- In the middle section, choose one of the three options by checking a box: If the business has obtained workers' compensation insurance, include the effective date and account number. If the business is exempt or has no employees, check the second box. If self-insured, check the third box and provide the effective date and certificate number.
- Proceed to the next section to indicate the license application type by selecting the appropriate box and entering the applicant's name, telephone number, and residential address.
- At the bottom of the form, sign and date in the provided area. If the form is executed in Nevada, use the first line; if outside Nevada, use the second line.
- Finally, review all entered information for accuracy, then save your changes. You can choose to download, print, or share the completed form as needed.
Complete the NV DIR Form D-25 online today to ensure your business complies with Nevada's industrial insurance requirements.
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