AFFIDAVIT OF EXEMPT STATUS UNDER THE WORKERS COMPENSATION CODE 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your name and the county where you are submitting the affidavit. This establishes your identity and jurisdiction.
3. In the first section, provide a detailed statement under oath regarding your status as an independent contractor. List any relevant points that support your exempt status.
4. Complete the section where you identify the contractor you will be working with, including their name and the calendar year for which this affidavit applies.
5. Review and check off statements in the Exempt Status Fact Sheet that apply to your situation. Ensure at least six statements are checked to confirm your independent contractor status.
6. Sign and date the affidavit, ensuring that all information is accurate and truthful to avoid penalties for false information.
7. Finally, have the document notarized before submitting it to your general contractor as instructed.

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