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WorkforceSafety. com APPLICATION FOR INSURANCE EMPLOYER SERVICES / PHS DIVISION SFN 5556 092008 PLEASE TYPE OR PRINT USING BLACK OR BLUE INK FOR WSI USE ONLY Employer Account Number Effective Date of Coverage Expiration Date - Payroll Period GENERAL INFORMATION Legal Name of Entity or Individual SIC Code NAICS Trade Name of Business or DBA if different from legal name Web Site Address Federal Employer I. Place Where Work Is Performed Description of Work Estimated payroll include Performed...

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How to fill out ND WSI Insurance Application Form

1. Gather necessary documents: Collect all relevant personal and business information needed for the application.
2. Start the form: Access the ND WSI Insurance Application Form either online or as a physical copy.
3. Fill out basic information: Provide your name, address, and contact details at the beginning of the form.
4. Enter business details: If applicable, include your business name, type, and any additional relevant operational information.
5. Detail the type of coverage needed: Specify the type of workers' compensation coverage required based on your industry.
6. Include employee information: List the number of employees and their respective job classifications.
7. Review and sign: Carefully review all filled-out information for accuracy and sign the form.
8. Submit the application: Send the completed application to the appropriate ND WSI office via email or postal service.

Who needs ND WSI Insurance Application Form?

1. Businesses operating in North Dakota that employ workers and require workers' compensation insurance.
2. Employers who need to comply with North Dakota state laws regarding worker injury protection.
3. Startups and employers of independent contractors in the state looking for coverage.

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What is ND WSI Insurance Application Form?

The ND WSI Insurance Application Form is a document used to apply for workers' compensation insurance in North Dakota. It collects essential information from employers to assess their coverage needs.

Who is required to file ND WSI Insurance Application Form?

Employers in North Dakota who are required to provide workers' compensation coverage for their employees must file the ND WSI Insurance Application Form.

How to fill out ND WSI Insurance Application Form?

To fill out the ND WSI Insurance Application Form, employers must provide their business details, such as the name, address, and type of business, along with information about their employees and the nature of the work performed.

What is the purpose of ND WSI Insurance Application Form?

The purpose of the ND WSI Insurance Application Form is to initiate the process of obtaining workers' compensation insurance coverage for employees, ensuring that businesses comply with state laws.

What information must be reported on ND WSI Insurance Application Form?

The ND WSI Insurance Application Form requires reporting information such as the employer's business name, address, contact information, ownership structure, nature of business activities, estimated payroll, and the number of employees.