Application for Elective Coverage of Excluded Employments
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| Title |
 Application for Elective Coverage of Excluded Employments (144 KB PDF)
|
|
| Description | Used by employers to request coverage of workers' compensation for non-mandatory employment. Shows a list of employment categories to choose from that are not included within the mandatory coverage of workers' compensation. |
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| Detail | ||
| Form number | F213-112-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | ||
| Languages | English | |
| Valid dates | 03-2013 | |
| Contact information |
Managing Injured Workers' Claims
|
|
| Web pages | Insurance for Business | |
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