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Click ‘Get Form’ to open the Maine Workers Compensation Waiver in the editor.
Begin by entering the applicant's name and contact information in the designated fields. Ensure accuracy as this information is crucial for processing.
Next, fill in the employer's details, including their name, address, and phone number. This section helps establish the relationship between the applicant and employer.
Select the type of business structure from options such as Sole Proprietor, Partnership, or Corporation. This selection is important for legal classification.
Indicate your relationship to the employer by checking one of the options under sections I, II, or III. Make sure to provide any required additional information regarding stock ownership if applicable.
Review the waiver statement carefully before signing. Confirm that all provided information is truthful and accurate.
Finally, sign and date the form electronically using our platform’s signature feature to complete your submission.
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This guidance document provides an approach that is generally acceptable to DEP for determining contaminant specific clean-up goals for soil, groundwater and
Waivers for Workers Compensation Insurance Application. For more information regarding the waivers, please contact Lori McGillicuddy at (207) 287-7054.
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