C105 2 form 2025

1. Click ‘Get Form’ to open the c105 2 form in the editor.
2. Begin by entering the Legal Name and Address of the Insured in section 1a. Ensure you use only the street address for accuracy.
3. In section 1b, input the Business Telephone Number of the Insured. This is essential for contact purposes.
4. Fill in section 1c with the NYS Unemployment Insurance Employer Registration Number of the Insured, followed by their Federal Employer Identification Number or Social Security Number in section 1d.
5. Next, provide the Name and Address of the Entity Requesting Proof of Coverage in section 2. This identifies who will receive this certificate.
6. In section 3a, enter the Name of Insurance Carrier and Policy Number from box '1a' in section 3b. If applicable, specify any Work Location in section 3c along with Policy effective period.
7. Finally, confirm if all Proprietors, Partners, or Executive Officers are included by checking the appropriate box in section 3d before signing and dating at the bottom.

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