Maryland officer inclusion for workers compensation 2002 form-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the current date in the designated field. This is important for record-keeping and processing your application.
3. Next, indicate the date when your insurance company was notified about your election for coverage. This helps establish a timeline for your request.
4. Fill in the name of your insurance company accurately to ensure proper communication regarding your coverage.
5. Provide your company name, address, city, state, and ZIP code in the respective fields. Ensure all information is correct to avoid delays.
6. In the section labeled 'Name and Title of Person Electing Coverage', enter your full name and title as required.
7. Input your Social Security Number in the specified field. This is necessary for identification purposes.
8. Finally, sign the form in the 'Personal Signature' area to validate your election for coverage.

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