Insurance Form Erm 14

Erm 14 form confidential request for ownership information effective 01 dec 2003 all items must be answered completely or the form may be returned.

Insurance form erm 14. 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. Submit your experience rating ownership request online including electronic signature. It ensures that the state can provide accurate proof of workers compensation coverage.

Erm 14 form confidential request for ownership information all items must be answered completely or the form may be returned. Wc programs department subject. The following confidential ownership statements may be used only in establishing premiums for your insurance coverages. It asks for very detailed information about changes in ownership.

Below is the erm 14 form that needs to be completed when there is a change in entity regarding name structure and or ownership. 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. The following confidential ownership statements may be used only in establishing premiums for your insurance coverages. Entities may be combined for experience rating if two or more entities wish to be written on one policy.

Instructions for erm 14. Instructions for completing an erm 14 form i. Purpose and effective date of change a. Combination of separate entities 1.

The erm 14 form may be submitted via online application or pdf for reporting changes in ownership mergers consolidations or a combination of entities. Once it is completed the form needs to be submitted to the wcrib workers compensation rating and inspection bureau and the carrier that currently insures the risk being updated. Section a type of transaction. Erm 14 form instructions pdf erm 14 form pdf ncci page content right top.

For many people this form seems somewhat complicated to complete. Erm 14 form confidential request for ownership information effective 01 dec 2003 all items must be answered completely or the form may be returned. Two or more entities sharing common ownership more than 50 common ownership in each entity.