Application for Split Coverage Wrap Up - Kentucky - Kentucky 2026

1. Click ‘Get Form’ to open the Application for Split Coverage Wrap Up in our editor.
2. Begin by entering your employer's name and address in the designated fields. Ensure that you also include the Federal Employer Identification Number (FEIN) for accurate identification.
3. In the section requesting details about the type of business, specify the principal work force engaged in operations at locations other than the wrap-up policy location.
4. Fill in the insurance policy number and carrier information for both the primary and separate work forces. Make sure these details are correct to avoid any processing delays.
5. Complete the date fields and provide a signature from a representative of your organization. This step is crucial for validating your application.
6. Finally, ensure that a notary public witnesses your signature, completing this important legal requirement before submission.

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