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STATE OF NEW YORK WORKERS COMPENSATION BOARD CERTIFICATE OF NYS WORKERS COMPENSATION INSURANCE COVERAGE 1a. Legal Name & Address of Insured (Use street address only) 1b. Business Telephone Number

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How to fill out certificate of nys workers

How to fill out NYS certificate of workers:

01

Gather necessary information: Before filling out the NYS certificate of workers, gather all the relevant information such as the worker's name, address, social security number, and employment details.

02

Start with the top section: Begin by entering the worker's name, address, and social security number in the appropriate fields. Double-check these details for accuracy to avoid any issues later on.

03

Provide employment information: In the next section, you will need to provide details about the worker's employment. This includes the name and address of the employer, as well as the worker's job title and duties.

04

Indicate the dates of employment: Specify the exact dates the worker was employed by the employer. This should include the start and end dates, or if the worker is still currently employed, indicate that as well.

05

Describe the worker's responsibilities: Use this section to briefly describe the worker's responsibilities and duties. This can include information about the tasks performed and the skills required for the job.

06

Enter the wage information: Provide details about the worker's wages, including the hourly or weekly rate, as well as any overtime or bonuses received. Ensure that all wage information is accurate and up-to-date.

07

Sign and date the form: Once you have completed filling in all the necessary information, sign and date the NYS certificate of workers to certify its accuracy. If there are multiple pages, make sure to sign each page.

08

Keep a copy for your records: Before submitting the form, make a copy for your own records. This will serve as a reference in case any discrepancies or issues arise in the future.

Who needs NYS certificate of workers?

01

Employers: Employers in New York State are required to fill out the NYS certificate of workers for their employees. This certificate helps in maintaining accurate records of employment and wage information.

02

Employees: Workers may also benefit from having a copy of the NYS certificate of workers for their personal records. It provides them with a summary of their employment details, including wages and job responsibilities.

03

Government Agencies: Various government agencies, such as the New York State Department of Labor or the Internal Revenue Service, may require the NYS certificate of workers for audit purposes or to ensure compliance with labor laws.

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What is nys certificate of workers?

The NYS Certificate of Workers' Compensation Insurance is a form that certifies an employer has workers' compensation coverage for their employees.

Who is required to file nys certificate of workers?

All New York State employers are required to file the NYS Certificate of Workers' Compensation Insurance.

How to fill out nys certificate of workers?

Employers can fill out the NYS Certificate of Workers' Compensation Insurance online or by mail with their insurance carrier.

What is the purpose of nys certificate of workers?

The purpose of the NYS Certificate of Workers' Compensation Insurance is to provide proof that an employer has workers' compensation coverage for their employees.

What information must be reported on nys certificate of workers?

The NYS Certificate of Workers' Compensation Insurance requires information such as the employer's name, address, policy number, and effective dates of coverage.

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