Erm 14 fillable form 2026

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The ERM-14 Form is a confidential document used to report ownership changes for insurance purposes, specifically for workers' compensation policies. It requires complete and accurate information about the entities involved in ownership transactions, including mergers, sales, or changes in legal status. The form must be submitted to the appropriate rating organization within 90 days of any change, and it includes sections for detailing transaction types, entity information, ownership details, and additional relevant information.

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Click ‘Get Form’ to open the Erm 14 fillable form in the editor.
Begin with Section A, where you will check the applicable transaction types and enter the effective and reported dates. Ensure all fields are filled accurately to avoid delays.
Proceed to complete Entity 1 details in Column A, including the name, Risk ID, FEIN, and type of entity. Make sure to provide a primary address and contact information.
Repeat for Entity 2 in Column B and Entity 3 in Column C as necessary. Pay attention to the ownership structure and ensure all relevant entities are included.
In Section B, answer questions regarding ownership history and any changes that have occurred. Provide additional information if required.
Finally, complete Section E by certifying that all information is accurate. Include your signature, title, and date before submitting the form.

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Who completes an ERM-14 form?

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 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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