Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers

Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers - (Forms/Publications)
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Title   Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers (159 KB PDF)
Description

Used by an employer to cancel workers' compensation coverage for Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers.

Detail
Form number F213-004-000
Availability
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Keywords cancel, industrial insurance, insurance coverage, insurance reporting, member coverage, officer coverage, optional coverage, owner coverage, voluntary coverage, worker's compensation, workers compensation
Languages English
Valid dates 07-Year
Contact information Managing Injured Workers' Claims
Related information
Documents

Application for Elective Coverage - Sole Proprietor, Partners, For-Profit Corporate Officers, or Member/Managers of Limited Liability Company (LLC)


Application for Exclusion/Inclusion - Mandatory Coverage (Family Farm)


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