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Sole proprietor workers' compensation waiver form - Eco Solutions ... 2025

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The document is a Workers' Compensation Waiver Form for business owners or principals who do not employ workers while conducting operations. It outlines the conditions under which a business owner can waive their rights to Workers' Compensation coverage, emphasizing the need for compliance with state laws if employees are hired in the future. The form requires the business owner's information and signature, and instructs them to fax the completed form.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your business name in the designated field labeled 'I am business owner doing business as...'.
Fill in your SSN or FEIN number, followed by your telephone number in the respective fields.
Provide your complete address, including city, state, and zip code in the appropriate sections.
Review the waiver statement carefully to ensure you understand that you are waiving your rights to Workers’ Compensation coverage.
Sign and date the form at the bottom where indicated.
Once completed, save your document and fax it to 1-800-508-1671 as instructed.

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