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CA OFFICER EXCLUSIONS WAIVER Insured Name Insurer Midwest Employers Casualty Company Policy Number GENERAL PARTNERS AND LLC MANAGING MEMBERS WAIVER OF WORKERS COMPENSATION COVERAGE Pursuant to California Labor Code section 3352 q I hereby certify under penalty of perjury that I am a general partner if the insured is a partnership or a managing member if the insured is a limited liability company of the above-named insured. As a qualifying general partner or managing member I elect to be...
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How to fill out ca officer exclusions waiver
How to fill out ca officer exclusions waiver
01
Obtain the CA Officer Exclusions Waiver form from the relevant authority or website.
02
Carefully read and understand all the instructions mentioned in the form.
03
Fill in your personal information, such as your name, address, and contact details, accurately and legibly.
04
Provide details about the officer exclusions you are seeking waiver for, including the specific incidents or reasons.
05
Attach any supporting documents or evidence, if required.
06
Review your completed form for any errors or omissions.
07
Sign and date the form in the designated areas.
08
Submit the filled-out form and any necessary documentation to the designated authority or address.
09
Keep a copy of the filled-out form and supporting documents for your records.
10
Await notification or response from the authority regarding the status of your officer exclusions waiver application.
Who needs ca officer exclusions waiver?
01
CA Officer Exclusions Waiver is needed by individuals who have been excluded or restricted from holding a certain officer position due to legal or disciplinary reasons.
02
This waiver provides an opportunity for individuals to request an exemption or clearance from such exclusions, allowing them to potentially hold officer positions in the future.
03
It is particularly relevant for individuals who have resolved their legal or disciplinary issues and wish to regain eligibility for officer roles in California.
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