Erm 14 form ny 2025

See details

4.7 out of 5

63 votes

The document outlines the ERM-14 form, a confidential request for ownership information required for establishing insurance premiums. It details the necessary steps and information needed to report ownership changes, including types of transactions such as mergers, sales, and entity formations. The form must be completed accurately and submitted to the Rating Board's Underwriting Department within 90 days of any ownership change. It emphasizes the importance of providing complete ownership details and includes sections for certification and additional information.

Here's how it works

01. Edit your erm 14 fillable online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send erm 14 via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out erm 14 form ny with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the erm 14 form in the editor.
Begin with Section A, entering the effective date of the transaction and the report date. Ensure all ownership changes are clearly documented.
Complete columns A, B, and C for each entity involved. Provide names, types of entities, and relevant identification numbers as required.
In Section B, answer questions regarding previous names and ownership relationships. Be thorough to avoid delays in processing.
Use Section C for any additional information that may not fit within the form's structure. Attach a narrative if necessary.
Finally, ensure you complete Section E by certifying that all information is accurate and sign where indicated.

Start using our platform today to fill out your erm 14 form easily and for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an ERM-14 form used for?

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?

What is a Erm letter? An EMR letter, sometimes called an E-Mod letter, is a note that details your companys experience modification rating. An experience modification rating is a number that communicates your companys history of workplace injury in comparison to other companies in your industry.

Who completes 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!

What is an ERM-14 form 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.