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- Click ‘Get Form’ to open the Office of Claims Administration (OCA)Mass document in the editor.
- Begin by filling out the Applicant Information section. Print your name, address, city/state/zip, and phone number clearly.
- Indicate your employment status by checking the appropriate box. If you are a general contractor, ensure to list your sub-contractors on the attached sheet.
- Select the type of project you are undertaking from the provided options. This is a required field.
- If applicable, provide your workers’ compensation insurance details including the insurance company name, policy number, and expiration date.
- Attach a copy of your workers’ compensation policy declaration page as instructed.
- Finally, certify that all information is accurate by signing and dating the affidavit before submission.
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