Co workers compensation 2026

1. Click ‘Get Form’ to open the co workers compensation form in the editor.
2. Begin by entering the name of your agency in the designated field. Ensure accuracy as this identifies your organization.
3. Input your Federal Employer Identification Number (FEIN) and business phone number. This information is crucial for identification and communication.
4. Fill in your mailing address, including street or P.O. Box, city, state, and zip code. This ensures that all correspondence reaches you promptly.
5. If you are a self-insured employer, enter your permit number; otherwise, provide the name of your workers’ compensation insurance carrier along with the policy number.
6. Specify the upcoming policy period by indicating the start and end month/year.
7. List the governing body for your agency and detail any uncompensated officials you wish to exclude from coverage. Include their names and Social Security numbers as required.
8. Finally, sign and date the form to certify that all provided information is accurate and that officials have been notified of their exclusion.

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