Erm 14 Insurance Form

The erm 14 form may be submitted via online application or pdf for reporting changes in ownership mergers consolidations or a combination of entities.

Erm 14 insurance form. Instructions for completing an erm 14 form i. It ensures that the state can provide accurate proof of workers compensation coverage. The erm 14 form is generally used to report changes in ownership resulting from sales mergers and other events. Section a type of transaction.

The erm 14 confidential request for ownership information form is a workers compensation form developed by ncci the national council on compensation insurance to report changes in ownership. Why the erm 14 form is important there are a couple of reasons why filling out the form promptly is so important including. Below is the erm 14 form that needs to be completed when there is a change in entity regarding name structure and or ownership. Request for ownership information erm 14 form the purpose of this confidential form is to obtain ownership information to assist in calculating premium for your workers compensation insurance policy.

Erm 14 is a form used to report ownership changes in a business for the purpose of determining the combinability transfer retention or possible exclusion of prior workers compensation claim and payroll data used in experience rating the new business entity. For many people this form seems somewhat complicated to complete. Any entity with exposure in multiple states should complete the national version of the erm 14 form and submit to the national council on compensation insurance inc. Entities may be combined for experience rating if two or more entities wish to be written on one policy.

The following confidential ownership statements may be used only in establishing premiums for your insurance coverages. Two or more entities sharing common ownership more than 50 common ownership in each entity. Combination of separate entities 1. It asks for very detailed information about changes in ownership.

Erm 14 form confidential request for ownership information all items must be answered completely or the form may be returned. Submit your experience rating ownership request online including electronic signature. Erm 14 form instructions pdf erm 14 form pdf ncci page content right top. The following confidential ownership statements will be used only in establishing premiums for your insurance coverage s.