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Massachusetts workers comp affidavit fillable 2007 form-2026
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- Click ‘Get Form’ to open the Massachusetts Workers Comp Affidavit in our editor.
- Begin by entering your name, address, and phone number in the Applicant Information section. Ensure all details are printed legibly.
- Indicate your employment status by checking the appropriate box: general contractor, sole proprietor, homeowner, or corporation. If applicable, provide details about your employees and subcontractors.
- Specify the type of project you are undertaking by selecting one from the list provided. This is a required field.
- If you are an employer providing workers' compensation insurance, fill in your insurance company name, policy number, and job site address. Attach a copy of your workers’ compensation policy declaration page.
- Finally, certify that the information is true by signing and dating the affidavit before submitting it to the relevant city or town office.
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*Any applicant that checks box #1 must also fill out the section below showing their workers compensation policy information.