Electronic Form CE 200 Fillable Template

Exemption from workers compensation insurance can only be provided by the NYS Workers Compensation Board via the issuance of the CE-200. The CE-200 is only available from Workers Compensation Board. The form can be completed either electronically. CE-200 Certificate of Attestation of Exemption From New York State Workers Compensation and/or Disability Insurance Coverage What is the CE-200 form Who provides the CE-200 form Why it is needed When is it needed Who is the certificate holder Who are the additional insureds Acceptable proof that the business listed is exempt from providing workers coverage. Please review the separate instructions form CE-200 instructions prior to completing this application. Please print clearly. Wcb. state. nv.us. Click the WCIDB Exemption button on the Board s main webpage and then click on Request for WCIDB Exemption Form CE-200. The Research Foundation of the State University of New York N/A The CE-200 can be completed electronically on the Workers Compensation Board web site. The next page provides a sample of a CE-200 Certificate of Attestation of Exemption From New York State Workers Compensation and/or Disability Insurance Coverage. There is no equivalent private insurance version of the CE-200 Certificate of Attestation of Exemption From New York State Workers Compensation and/or Disability Insurance Coverage. To establish proof that a business is exempt from providing workers compensation and/or disability insurance coverage for all its employees. Prior to any permit being issued or any contract including purchase orders being entered into for work. which employees are engaged in hazardous employment as defined under article 1 section 3 of the New York State Workers Compensation law. The Workers Compensation Law requires employers to post Form C-105 Notice of Compliance Workers Compensation Law in all business locations. Employers involved in moving household goods or furniture and/or employers who have no established business locations for employees are required to post a Notice of Compliance C-105. 1 in vehicles they own or operate. The C-105 and the C-105. 1 can be obtained from the State Insurance Fund and was also provided in the renewal information package that employers receive. This process may take up to four weeks. To obtain a certificate immediately please use the on-line application at www. wcb. state. ny. us. Once the application is completed on-line you can immediately print the certificate on your printer. 1. Applicant Personal Information First Name Last Name Street Address City State Zip Country If other than U*S* Personal Phone Number 2. Your Title check only one Sole Proprietor Treasurer President Partner Member Secretary Trustee Homeowner Board Member Other please provide title 3. Legal Entity Information Business Federal ID If none enter social security number Legal Entity Name Doing Business As Name Business Phone E-mail Check here if business address is the same as the applicant s personal address.