| Form Number |
State |
Name/Description |
| 151 |
|
Miscellaneous Crime Coverage Section |
| 154 |
|
Jewelers Inventory Record |
| 155 |
|
Boiler & Machinery Section |
| 160 |
|
Business Owners Application |
| 161 |
|
Business Owners Supplemental App |
| 163 |
|
Commercial Auto Driver Information
Schedule |
| 165 |
|
Small Commercial Account Package App |
| 171 |
AK |
Alaska Petition for Executive Officer
Waiver |
| 171 |
CO |
Colorado Rejection of Coverage by Corporate
Officers |
| 171 |
CT |
Workers' Compensation Commission of
Connecticut |
| 171 |
DE |
Delaware Workers Compensation Election |
| 171 |
FL |
Florida Notice of Election of Coverage
Under Workers Compensation Law |
| 171 |
GA |
Georgia State Board of Workers Compensation
Corporate Rejection |
| 171 |
KS |
Kansas Election of Individual Partner
or Self-Employed Individual |
| 171 |
MI |
Michigan Notice of Election |
| 171 |
NM |
New Mexico Executive Employee Exemption |
| 171 |
NY |
New York Notice of Election of a Corporation |
| 171 |
PA |
Pennsylvania Application for Executive
Exception From the Provisions of the Pennsylvania Workers' Compensation
Act: Section 104 |
| 171 |
TN |
Notice of Corporate Officer to Employer
of Not to Accept Provisions of the "Compensation Act" of Tennessee |
| 171 |
VA |
Rejection of Coverage Under The Virginia
Workers' Compensation Act |
| 172 |
CT |
Workers' Compensation Commission of
Connecticut |
| 172 |
FL |
Florida Certificate of Exemption of
Coverage Workers Compensation Law |
| 172 |
GA |
Georgia State Board of Workers Compensation
Notice of Election to Accept |
| 172 |
KS |
Kansas Cancellation of Election of
Individual |
| 172 |
MI |
Michigan Application for Exclusion
of Partner(s) |
| 172 |
NM |
New Mexico Election to Accept |
| 172 |
NY |
New York Notice of Election of a Partnership
or Sole Proprietorship to Bring Partners or Self-Employed Persons
Under the Coverage of the New York Workers Compensation Law |
| 172 |
PA |
Pennsylvania Executive Officers Affidavit |
| 172 |
VA |
Virginia Notice Terminating Prior Rejection
of Coverage |
| 173 |
CT |
Workers' Compensation Commission of
Connecticut |
| 173 |
FL |
Construction Industry Certificate of
Election to be Exempt From the Florida Workers' Compensation Law |
| 173 |
KS |
Kansas Cancellation of Election Not
to Accept Coverage |
| 173 |
MI |
Michigan Workers Compensation
Placement Facility Specific Person Exclusion Form |
| 173 |
NM |
New Mexico Revocation |
| 173 |
NY |
New York Notice of Election of an Incorporated
Religious |
| 174 |
KS |
Kansas Election Not to Accept Coverage |
| 174 |
NY |
New York Revocation of an Incorporated
Religious |
| 175 |
|
Commercial Policy Change Request |
| 175 |
FL |
Florida Workers Compensation Monthly
Change Sheet |
| 176 |
KS |
Kansas Election of Employer to Cover
Employees |
| 177 |
KS |
Kansas Election of Coverage for Volunteer
Workers |
| 177 |
WI |
Wisconsin Automobile Insurance Plan |
| 177 |
NY |
Application for Basic Insurance - New
York Property Insurance Underwriting Association |
| 178 |
WI |
Wisconsin Automobile Insurance Plan |
| 180 |
|
Errors and Omissions Section |
