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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 fields are filled accurately to avoid delays.
Complete the entity information for each applicable column (A, B, C) by providing names, types of entities, and contact details as required.
In Section B, answer questions regarding ownership and relationships between entities. Be thorough in your responses to ensure clarity.
Use Section C for any additional information that may not fit within the form's structure. Attach a narrative if necessary.
Finally, complete Section E by certifying that all information is accurate and sign where indicated. This step is crucial for processing your submission.
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The ERM-14 form is used to request ownership information and may be used in a variety of instances, including when there has been a change in ownership, when an entity needs to be added later or when multiple entities need to be considered for combinability.
When should an ERM-14 be completed?
The ERM-14 is used to report any of the following business changes: Business name and/or legal entity change. Sale, merger, acquisition or consolidation of entities. Transfer of assets. Formation of a new entity. Placement of a business into a trust or receivership. To determine the combinability of separate entities.
What is the ERM-14 form?
The purpose of this confidential form is to obtain ownership information to assist in calculating premium for your workers.
How do I submit an ERM-14 to NCCI?
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!
How do I get a NCCI risk ID?
Where do you get a Risk ID? You or your insurance broker can typically access this number online through NCCI or your state bureau by searching with your FEIN or corporate name. You can also find it by looking on your workers compensation policy.
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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.
erm 14 form ny
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