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Workers comp affidavit ma 2026

The document is a Workers’ Compensation Insurance Affidavit from the Commonwealth of Massachusetts Department of Industrial Accidents, designed for builders, contractors, electricians, and plumbers. It requires applicants to provide information about their business, employee status, and insurance coverage for workers' compensation. The affidavit must be completed accurately to comply with Massachusetts General Laws chapter 152, which mandates that employers secure workers' compensation insurance for their employees. Failure to comply may result in penalties. The document also includes instructions for city or town officials regarding the processing of the affidavit.

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Click ‘Get Form’ to open the workers comp affidavit ma in the editor.
Begin by filling in your applicant information. Enter your name, address, city/state/zip, and phone number clearly.
Indicate your employment status by checking the appropriate box. Choose from options such as general contractor, sole proprietor, homeowner, or corporation.
Specify the type of project you are undertaking by selecting one of the provided options like new construction or remodeling.
If applicable, provide your workers' compensation policy information including the insurance company name and policy number. Attach a copy of the declaration page.
Finally, certify that all information is accurate by signing and dating the affidavit before submitting it to your local city or town office.

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Versions	Form popularity	Fillable & printable
2019	4.9 Satisfied (59 Votes)
2013	4.8 Satisfied (486 Votes)
2007	4 Satisfied (57 Votes)
2006	4 Satisfied (33 Votes)

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