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AFFIDAVIT OF WORKERS COMPENSATION COVERAGE N. C. GENERAL STATUTE 8714 ___, Contractor ___, Owner ___, Officer/Agent of the Contractor or Owner does hereby aver under penalties of perjury that the
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How to fill out affidavit of workers compensation

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How to fill out affidavit of workers compensation

01
Obtain an affidavit of workers compensation form from your employer or the relevant government agency.
02
Clearly read and understand the instructions provided with the form.
03
Fill in your personal information accurately, including your name, contact details, and social security number.
04
Provide detailed information about the employer you are claiming workers compensation from, such as their name, address, and contact information.
05
Explain the details of your injury or illness, including when and where it occurred, and the specific circumstances surrounding it.
06
Attach any necessary supporting documents, such as medical records, accident reports, or witness statements.
07
Review the completed form for accuracy and completeness.
08
Sign and date the affidavit.
09
Submit the filled-out form to the appropriate party, such as your employer, insurance company, or workers compensation board.

Who needs affidavit of workers compensation?

01
Any employee who has suffered a work-related injury or illness and wishes to claim workers compensation benefits needs an affidavit of workers compensation.
02
Employers may also require their employees to fill out this affidavit to initiate the claims process.
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Affidavit of workers compensation is a legal document signed by an employer verifying that they have workers' compensation insurance coverage for their employees.
All employers who have employees are required to file an affidavit of workers compensation.
Affidavit of workers compensation can be filled out by providing information about the company, insurance policy details, and signing the document.
The purpose of affidavit of workers compensation is to ensure that employers have insurance coverage in place to provide benefits to employees in case of a work-related injury or illness.
Information such as company name, address, policy number, insurance provider, and effective dates of coverage must be reported on the affidavit of workers compensation.
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