Maine predetermination form: Fill out & sign online

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Click ‘Get Form’ to open the WCB-265 application in the editor.
Begin by filling in your Operator Name and any 'doing business as' (d/b/a) name if applicable. Ensure that your physical and mailing addresses are accurate.
Provide your contact information, including telephone number and email address, ensuring all details are correct for effective communication.
Answer the initial question regarding your workers’ compensation insurance policy. If you have coverage, attach a copy of the document; otherwise, proceed to the next questions.
Respond to each of the subsequent questions about vehicle ownership, maintenance responsibilities, operating expenses, personal expenses, service provision, compensation structure, and control over service delivery. Attach necessary documentation as required.
Finally, read the certification statement carefully before signing and dating it at the bottom of the form. This confirms that all provided information is truthful.

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