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TOWN OF CLAYTON Date Received: ___Engineering & Inspections111 E. Second St., P.O. Box 879 Clayton, NC 27528 Phone: 9195535002 Fax: 9195531720AFFIDAVIT OF WORKERS COMPENSATION COVERAGE N.C.G.S 8714

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How to fill out affidavit of workers compensation

01

Obtain the affidavit of workers compensation form from the appropriate department or website.

02

Fill in your personal information including name, address, and contact details.

03

Provide details about your employment history such as the date of hire and job title.

04

Include information about the injury or illness that occurred at the workplace.

05

Sign and date the affidavit in front of a notary public to validate the document.

Who needs affidavit of workers compensation?

01

Employees who have experienced a work-related injury or illness and are seeking compensation benefits.

02

Employers who require documentation of an employee's injury or illness for insurance and legal purposes.

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What is affidavit of workers compensation?

Affidavit of workers compensation is a legal document signed under oath by an employer or insurance carrier to verify that they are in compliance with workers compensation laws.

Who is required to file affidavit of workers compensation?

Employers or insurance carriers are required to file affidavit of workers compensation.

How to fill out affidavit of workers compensation?

To fill out the affidavit of workers compensation, one must provide accurate information about their workers compensation coverage, compliance with laws, and other required details.

What is the purpose of affidavit of workers compensation?

The purpose of affidavit of workers compensation is to ensure that employers and insurance carriers are meeting their legal obligations to provide workers compensation benefits.

What information must be reported on affidavit of workers compensation?

Information such as proof of coverage, compliance with laws, and other relevant details must be reported on affidavit of workers compensation.

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