Proprietor/Partner/Corporate Officer Form

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Proprietor Partner CorporateOfficer Form

https://www.dvins.com/download%20files/Proprietor_Partner_CorporateOfficer_Form.pdf

Proprietor/Partner/Corporate Officer Form (If not established on DE-9c) To establish the relationship between proprietors, partners, and/or corporate officers to the below referenced company, please complete and return this form. I attest that, although my name does not appear on the DE 9c wage report of the below-named

PARTNER’S, SOLE PROPRIETOR’S OR CORPORATE OFFICER’S …

https://www.floir.com/siteDocuments/OIR-B1-1562.DOC

Partner’s, Sole Proprietor’s or Corporate Officer’s Statement. Name of Insurance Carrier: Name of Individual or Business Conducting the Audit: (If other than an employee of the Insurance Company) Name of Insured: Policy Number: Policy Period From: to. Partner’s, Sole Proprietor’s or Corporate Officer’s Statement.

DISCLOSURE OF COMPANY OWNERS, PARTNERS, OFFICERS

http://www.commerce.state.mn.us/Licensing/BCA_Owners.pdf

Individual Proprietor •: Provide the name and address of the Owner. • Partnership: Provide the name and address of all General Partners and Limited Partners. • Corporation, LLC, Trust, Other: Provide the name and address of all elected Officers, Directors, Governors, Members, Shareholders owning 10% or more of company stock, and anyFile Size: 45KB

CORPORATE OFFICERS, MEMBERS, MANAGERS, PARTNERS, …

http://www.sls-ins.com/wp-content/uploads/2017/12/Officer-Election-Rejection-Form.pdf

Depending on your respective State Insurance or Labor Code, an Officer, Partner, Member, Manager, Sole Proprietor or Other individual may be required or permitted to either ELECT or REJECT workers compensation coverage. This form provides documentation of your decision as your state has not promulgated a form for this purpose.

OFFICE OF INSURANCE REGULATION Property & Casualty …

https://www.floir.com/siteDocuments/OIR-B1-1562.pdf

Property & Casualty Forms and Rates OIR-B1-1562 REV. 07/2003 PARTNER’S, SOLE PROPRIETOR’S OR CORPORATE OFFICER’S STATEMENT Name of Insurance Carrier: Name of Individual or Business Conducting the Audit: (If other than an employee of the Insurance Company) Name of Insured: Policy Number: Policy Period From: to

Business License Application - Washington State

https://dor.wa.gov/sites/default/files/legacy/Docs/forms/BLS/700028.pdf

6 Signature (Signature of Sole Proprietor or spouse, partner, corporate officer, or LLC member/manager) I, the undersigned, declare under the penalties of perjury and/or the revocation of any license granted, that I am the applicant or authorized representative of the firm making this application and that the answers contained,

Inclusion/Exclusion Forms – AmeriTrust Online

https://support.ameritrustgroup.com/index.php/additional-resources/workers-compensation-inclusionexclusion-forms/

SC – Form 5 – SC Corporate Officers Notice to Reject; Tennessee. TN – I-4 – TN Election of Sole Proprietor or Partner to come within the provisions of the TN WC Law; TN – I-6 – TN Notice of Corporate Officer to Employer of Election not to accept provisions of WC Act of TN rev 09_2010

ELECTION OR REJECTION OF COVERAGE FOR SOLE …

https://alicunderwriters.com/assets/documents/form-nc-officer-exclusion.pdf

PROPRIETORS, PARTNERS, MEMBERS OF LLC’S AND CORPORATE OFFICERS Note: ** Sole proprietors, partners and members of LLC’s are excluded from the North Carolina workers’ compensation laws and benefits unless coverage is elected in writing. ** Executive Officers of a Corporation a re covered under the North Carolina workers’

GEORGIA STATE BOARD OF WORKERS' COMPENSATION

https://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/board_forms/wc010.pdf

The use of this form is required under the provisions of: (A) O.C.G.A. §34-9-2.1 of the Workers' Compensation Law if a corporate officer or limited liability company member elects to reject coverage; (B) O.C.G.A. §34-9-2.2 if a sole proprietor or partner elects to …

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