Amtrust workers comp: Fill out & sign online

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Send waiver of subrogation workers compensation form via email, link, or fax. You can also download it, export it or print it out.

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Click ‘Get Form’ to open the CA Workers Compensation Officer Waiver Form in the editor.
Begin by entering the 'Entity Name' at the top of the form. This should be the name of your professional corporation.
In the certification section, confirm that you are an owner of a professional corporation and a practitioner rendering professional services. This is crucial for validating your eligibility for exclusion from workers' compensation coverage.
Indicate that you are covered by a health insurance policy or health care service plan, as this is a requirement for waiving workers' compensation coverage.
Sign and print your full name in the designated areas. Ensure that you also include your title and date of signing to complete the form accurately.
Review all entered information for accuracy before submitting. Once confirmed, submit the signed form to your broker as instructed.

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