Initial Workers Compensation Exemption
To qualify a Workers' Compensation Exemption Registration, the business entity must be identified and applicant details provided.
Qualification:
Qualification Type: *
FEIN: * xx-xxxxxxx What's this?
Entity Control #: * What's this?
The name will be shown after a Secretary of State Control # is entered.
Business Entity Name: *
 
Applicant:
First Name: * Middle Name:
Last Name: *
Birth Date: * mm/dd/yyyy
Last 4 SSN: *
Phone: * (xxx) xxx-xxxx
Confirm Phone: * (xxx) xxx-xxxx
Email:
Confirm Email: *