Workman s Compensation Waiver: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
In the first field, enter your name as the owner/operator of the company. Make sure to print it clearly.
Next, fill in your company name in the designated field. This identifies the business for which you are requesting a waiver.
Review the statement regarding workers' compensation coverage requirements carefully before signing.
Sign and date the form in the provided sections to confirm your request for exemption.
Finally, ensure that a Notary Public witnesses your signature and completes their section of the form.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (130 Votes)

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