Erm 14 2000 form-2026

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The document is a confidential request form for reporting ownership changes related to insurance coverages, specifically for workers' compensation policies. It outlines various scenarios such as name changes, mergers, sales, and the formation of new entities that require detailed information about ownership before and after the change. The form emphasizes the importance of timely reporting to the insurance carrier and includes sections for providing necessary details about the entities involved.

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Click ‘Get Form’ to open the erm 14 2000 form in the editor.
Begin by selecting the purpose of the form. Check one of the options provided, such as 'Name change only' or 'Sale, transfer or conveyance of ownership interest'.
Fill in Column A with the name and street address of the entity before any changes. Ensure that P.O. Box numbers are not used.
Complete Column B for the new entity details, including legal status and ownership information. If applicable, list owners with 5% or more voting stock.
Answer questions 1 through 3 on page two regarding previous names and related entities. Provide additional information if necessary.
Certify that all information is complete by signing at the bottom of the form, including your title and date.

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Versions	Form popularity	Fillable & printable
2003	4.9 Satisfied (460 Votes)
2000	4 Satisfied (48 Votes)

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What is the purpose of an ERM-14?

Any business that finds itself in a transformative process will most likely be introduced to the ERM-14, a form required by many state workers compensation bureaus to report changes in a businesss ownership, structure or status.

When to complete an ERM-14?

Instructions: Complete an ERM-14 for the change that occurred to require a determination of combinability (e.g., new entity formed, change in ownership, merger, etc.). After the first ERM-14 is complete, fill out a second ERM-14 for the combinability.

What is an ERM-14 form used for?

The ERM-14 is a confidential form completed by the insured and submitted to the NCCI for the purpose of assisting the various workers compensation bureaus to verify coverage and determine combinability of entities as it relates to premium calculation.

How do I submit an ERM-14 form?

The ERM-14 Form may be submitted via online application or PDF for reporting changes in ownership, mergers, consolidations, or a combination of entities. Submit Your Experience Rating Ownership Request Onlineincluding electronic signature! Other Options: ERM-14 Form Instructions (PDF)