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The ERM-14 is a confidential form completed by the insured and submitted to the NCCI for the purpose of assisting the various workers compensation bureaus to verify coverage and determine combinability of entities as it relates to premium calculation.
How to submit ERM-14?
The ERM-14 Form may be submitted via online application or PDF for reporting changes in ownership, mergers, consolidations, or a combination of entities. Submit Your Experience Rating Ownership Request Onlineincluding electronic signature!
What does ERM-14 stand for?
REQUEST FOR OWNERSHIP INFORMATIONERM-14 FORM. The purpose of this confidential form is to obtain ownership information to assist in calculating premium for your workers. compensation insurance policy. Your policy requires that you report ownership changes, and other changes as detailed.
What is an ERM-14?
The ERM-14 form is used to request ownership information and may be used in a variety of instances, including when there has been a change in ownership, when an entity needs to be added later or when multiple entities need to be considered for combinability.
How do I submit an ERM-14 form?
The ERM-14 Form may be submitted via online application or PDF for reporting changes in ownership, mergers, consolidations, or a combination of entities. Submit Your Experience Rating Ownership Request Onlineincluding electronic signature! Other Options: ERM-14 Form Instructions (PDF)
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Confidential Request for Information (ERM-14)
This is to docHub that the Information contained on this form is complete and correct. Name of Insured: Name of person completing the form: Date this
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