INDUSTRIAL COMMISSION OF THE STATE OF IDAHO APPLICATION - iic idaho 2025

1. Click ‘Get Form’ to open the INDUSTRIAL COMMISSION OF THE STATE OF IDAHO APPLICATION in the editor.
2. Begin by filling in the 'Applicant' and 'Parent Company' fields with the appropriate names. Ensure accuracy as this information is crucial for identification.
3. Enter the 'Main Office Address' and details of your 'Adjuster' along with their address. This section is vital for communication regarding claims.
4. Input your three-year payroll figures in the designated fields, ensuring that you provide accurate amounts for each year.
5. Complete the 'Security Deposited' section by specifying the amount and type of security you are providing, which is essential for self-insurance qualification.
6. List any wholly-owned subsidiaries by entering their names, FEIN numbers, and locations in the provided spaces. This helps clarify your business structure.
7. Review all entries for accuracy before signing. The officer must sign and print their name, along with their title, at the bottom of the form.
8. Finally, ensure that a notary public witnesses your signature to validate the document before submission.

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