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Certificate of Compliance Minnesota Workers Compensation Law PRINT IN INK or TYPE.Minnesota Statutes, Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal
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How to fill out mn workers compensation certificate

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How to fill out mn workers compensation certificate

01
Obtain the Minnesota Workers' Compensation Certificate form from the Minnesota Department of Labor and Industry website.
02
Fill in your business name and address in the appropriate fields.
03
Provide your Federal Employer Identification Number (FEIN) or Social Security Number (if a sole proprietor).
04
Indicate the type of business structure (e.g., corporation, partnership, sole proprietorship).
05
Fill out information regarding your workers' compensation insurance provider, including their name and policy number.
06
If you are self-insured, provide the required self-insurance details.
07
Sign and date the certificate, verifying that the information provided is correct.
08
Submit the completed certificate to the relevant Minnesota state agency or your insurance carrier as required.

Who needs mn workers compensation certificate?

01
Any business entity in Minnesota that has employees is required to obtain a Minnesota Workers' Compensation Certificate.
02
This certificate is necessary for employers to comply with state law regarding workers' compensation insurance.
03
Individuals or businesses hiring employees or subcontractors in Minnesota must also provide this certificate.
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The MN Workers Compensation Certificate is a document that verifies an employer's workers' compensation insurance coverage in the state of Minnesota.
All employers in Minnesota who have employees and are required to carry workers' compensation insurance must file the MN Workers Compensation Certificate.
To fill out the MN Workers Compensation Certificate, employers should provide their business information, insurance provider details, policy number, and coverage periods as required on the form.
The purpose of the MN Workers Compensation Certificate is to demonstrate compliance with state workers' compensation insurance laws and to provide proof of coverage for the protection of employees.
The MN Workers Compensation Certificate must include information such as the employer's name and address, insurance company information, policy number, effective dates of coverage, and any additional relevant details.
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