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Click ‘Get Form’ to open the instructions initial workers compensation exemption application in our editor.
Begin by filling out the 'Applicant Information' section. Enter your full legal name, date of birth, last four digits of your Social Security Number, phone number, and email address.
Provide your physical address, ensuring it is accurate and complete. If your mailing address differs from your physical address, include that as well.
In the 'Initial Qualification' section, select the appropriate qualification that applies to you. Remember, only one qualification can be selected.
Complete the 'Initial Business Entity' section by entering the business entity name and SOS Control number. Ensure these match official records to avoid rejection.
Fill in any required licensing information and attestations at the end of the form. Make sure to sign and date your application before submission.

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