Workers compensation letter of exemption
[DOC File]West Virginia Insurance Commission
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An employer is not entitled to a letter of exemption from West Virginia workers’ compensation coverage unless it meets one of the specific exemptions as set forth in W. Va. Code § 23-2-1(b)(1) through (8), or otherwise proves that the employer is exempt from West Virginia workers’ compensation laws because it does not fall under the ...
[DOCX File]SOLE PROPRIETOR EXCLUSION FORM
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do not carry Workers’ Compensation Insurance. *NOTE: All private employers and independent contractors regularly employing one or more employees for 35 hours or more per week for 13 weeks or longer with a 52-week period are employers under the Act and do not qualify for exclusion so should not complete this form.
[DOC File]Application for Self-Insurance
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, Exemption Provision Waiver, see Page 5, Item J. 14. List name of the current workers’ compensation insurance carrier: Name: Policy no.: Effective dates: to Attachment required – Declaration page from your workers’ compensation policy, see Page 5, Item K. 15.
[DOC File]Workers’ Compensation Insurance Affidavit
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____ Religious exemption under Workers’ Compensation Law. All employees of contractor are exempt from workers’ compensation insurance. (Attach copies of religious exemption letters for all employees). ____ Use this form when applicable to part “C” on the workers’ compensation form.
[DOC File]AFFIDAVIT OF EXEMPTION - Hampshire County
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Religious exemption. under the Workers’ Compensation Law. All employees of contractor are exempt from workers’ compensation insurance (attach copies of religious exemption letter for all employees). _____ Signature of Applicant Date. WV CODE §21-11-10. Prerequisites to obtaining building permit/ mandatory written contracts. ...
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