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PERMIT NO.:AFFIDAVIT WORKERS COMPENSATION INSURANCE COVERAGE MUST BE NOTARIZEDATTACH TO PERMIT APPLICATIONPursuant to Act 44, Commonwealth of Pennsylvania, effective Tuesday 31 August 1993, NO BUILDING
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01
Start by obtaining the workers compensation insurance affidavit form from DocsLib.org or the appropriate state agency.
02
Read through the form carefully to understand the information required and any instructions provided.
03
Gather all relevant information and documents that you will need to fill out the form accurately. This may include your business information, insurance policy details, and any previous workers compensation claims.
04
Begin by entering your business information such as the name, address, and contact details.
05
Provide details about your workers compensation insurance policy, including the name of the insurance carrier, policy number, and effective dates.
06
If applicable, disclose any previous workers compensation claims or incidents involving your business.
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Review the completed form to ensure all information is accurate and complete.
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Sign and date the workers compensation insurance affidavit.
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Submit the completed form as instructed, whether by mail, fax, or online submission.
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Keep a copy of the completed form for your records.

Who needs docsliborgworkers-compensation-insurance-affidavitworkers compensation insurance affidavit?

01
Any employer or business that has employees may need to fill out the workers compensation insurance affidavit. The exact requirement can vary by state, so it is important to check with the specific state agency or consult legal counsel to determine if your business needs to submit this form.
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The workers compensation insurance affidavit is a form that verifies an employer's compliance with providing workers compensation insurance coverage for employees.
All employers who have employees are required to file the workers compensation insurance affidavit.
Employers can fill out the workers compensation insurance affidavit by providing information on the form such as business details, insurance coverage provider, and policy numbers.
The purpose of the workers compensation insurance affidavit is to ensure that employers have workers compensation insurance coverage in place to protect employees in case of work-related injuries or illnesses.
Employers must report information such as business details, insurance coverage provider, policy numbers, and certification of compliance.
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