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Page 1. WC/DB-100 (9-07) Replaces Form C-105.21. (Over). NYS WEB .... Page 2. WC/DB-100 (9-07) Reverse 4b.) the business is an LLC, LLP, LLC, PULP ...

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What is nys workers compensation affidavit?

The NYS workers compensation affidavit is a form that employers in New York State must complete to certify their compliance with state workers compensation laws.

Who is required to file nys workers compensation affidavit?

All employers in New York State are required to file the NYS workers compensation affidavit.

How to fill out nys workers compensation affidavit?

Employers can fill out the NYS workers compensation affidavit online through the New York State Workers' Compensation Board website or submit a paper form by mail.

What is the purpose of nys workers compensation affidavit?

The purpose of the NYS workers compensation affidavit is to ensure that employers are providing workers compensation coverage for their employees as required by law.

What information must be reported on nys workers compensation affidavit?

Employers must report their company's name, address, FEIN, number of employees, and insurance carrier information on the NYS workers compensation affidavit.

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