Alabama exclude form 2026

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The document is a notice for employers in Alabama regarding the option for corporate officers, sole proprietors, or partners to elect to include or exclude themselves from workers' compensation insurance coverage. It outlines the process for making this election, including the requirement for written certification and the implications of choosing exclusion, such as lack of insurance protection in case of job-related injuries.

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Click ‘Get Form’ to open the Alabama exclude form in the editor.
In Part I, enter your full name where indicated. If you choose to be excluded from coverage, check the appropriate box and sign the form, including the date and your title.
If you wish to revoke your exemption and accept coverage, complete the second section of Part I by entering your full name again, checking the inclusion box, signing, dating, and providing your title.
Move to Part II if applicable. Here, enter your full name if you are a sole proprietor or part of a partnership. Sign and date this section as well.
Fill in your business name, mailing address, physical location, FEIN, UC number, WC insurance carrier details, policy number, effective date, and agency/phone information.
Ensure all fields are completed accurately before saving or exporting your document for submission.

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