Erm 14 Form PDF Details

The ERM 14 form is an important document for businesses and organizations of all sizes. The form helps companies manage risk and stay compliant with regulations. This guide provides an overview of the ERM 14 form, including its purpose and key components. Additionally, we'll discuss how to complete the form and what to do if you have any questions. Having a firm understanding of the ERM 14 will help you protect your business and ensure compliance with state and federal requirements.

The table contains specifics of the erm 14 form. There, you'll obtain the information about the PDF you would like to fill in, like the estimated time for you to complete it along with other data.

QuestionAnswer
Form NameErm 14 Form
Form Length4 pages
Fillable?Yes
Fillable fields192
Avg. time to fill out39 min 28 sec
Other nameserm form, how to erm 14, erm14, form 14

Form Preview Example

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. Your policy requires that you report ownership changes, and other changes as detailed below, to your insurance carrier in writing within 90 days of the change. If you have questions, contact your agent, insurance company, or the appropriate rating organization. Incomplete information or a missing signature may result in a delay in processing.

The ownership information required on this ERM-14 Form can also be submitted in narrative form on the letterhead of the employer, signed by an owner, partner, member, or executive officer.

Section A—Contact Information

Name of person completing this form ____________________________ Your Employer __________________________

Phone # _____________________________ Email Address ________________________________________________

Relationship to business entity reporting ownership information _______________________________________________

Section B—Transaction Information

Type of Transaction (check all that apply)

Transaction

Effective Date

Name and/or legal entity change

The name and/or legal status of the entity has changed. DBA name changes do not need to be reported.

Sale, transfer, or conveyance of all or a portion of an entity’s ownership interest

Complete or partial sale of the business entity’s ownership interest.

Sale, transfer, or conveyance of an entity’s physical assets to another entity that takes over its operations

An entity’s assets have been sold or transferred. The acquiring entity has taken over the operations, and the selling entity retained its legal business name.

Merger or consolidation

Two or more entities have merged or combined to form a single entity.

Formation of a new entity that acts as, or in effect is, a successor to another entity that:

(Select one)

Has dissolved

Is nonoperative

May continue to operate in a limited capacity

Formation of a new entity

A new entity has formed that is not a successor to another entity. Report this change only to determine combinability with another entity.

An irrevocable trust or receiver, established either voluntarily or by court mandate

A change has occurred to the business, either voluntarily or by court mandate, requiring the entity to be put in a trust or receivership.

Determination of combinability of separate entities

Two or more entities may need to be combined or separated based on their ownership interest.

Section C—Description of Transaction(s)

Include a brief description of the transaction(s) selected above. Attach additional information on the employer’s letterhead, if needed.

If this is a partial sale, transfer, or conveyance of an existing business (e.g., sale of one or more plants or locations), explain what portion or location of the entire operation was sold, transferred, or conveyed.

If any of the entities that underwent a change in ownership were related through common ownership to any other entity before the transaction described above, list the entities and their current owners’ names and percentages of ownership below.

ERM-14 (Rev. 2/20)

© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.

Page 1 of 2

Section D—Business Entity Information

Copies of this page may be submitted for transactions with more than three entities.

 

 

Entity 1

Entity 2

Entity 3

 

 

Entity before the change or

Entity after the change or

Entity after a merger or

 

Entity Information

to determine combinability

to determine combinability

consolidation or to determine

 

 

with another entity

with another entity

combinability with another entity

1.

Name of Business

 

 

 

 

Provide the legal name of the

 

 

 

 

business entity.

 

 

 

 

 

 

 

 

2.

Primary Address

 

 

 

 

(Street, City, State, Zip)

 

 

 

 

 

 

 

 

3.

Legal Status

 

 

 

 

(See examples in item 4 below)

 

 

 

 

 

 

 

 

4.

Ownership

 

 

 

 

List names of individual owners,

 

 

 

 

partners, etc. and percentages of

 

 

 

 

ownership (if applicable).

 

 

 

 

Ownership should total 100%.

 

 

 

Sole Proprietorship: Owner

 

 

 

Corporation: Owner(s) and

 

 

 

 

percentages of ownership

 

 

 

General Partnership:

 

 

 

 

Partners and percentages of

 

 

 

 

ownership

 

 

 

Limited Partnership:

 

 

 

 

General partners and

 

 

 

 

percentages of ownership

 

 

 

Limited Liability Company:

 

 

 

 

Members and percentages of

 

 

 

 

ownership

 

 

 

Revocable Trust: Grantor(s)

 

 

 

Irrevocable Trust: Trustee(s)

 

 

 

Other: If no voting stock, list

 

 

 

 

members of board of directors or

 

 

 

 

comparable governing body

 

 

 

 

 

 

 

 

5.

FEIN

 

 

 

 

 

 

 

 

6.

Risk ID Number

 

 

 

 

 

 

 

 

7.

Policy Number

 

 

 

 

 

 

 

 

8.

Policy Effective Date

 

 

 

 

 

 

 

 

9.

Contact Name

 

 

 

 

 

 

 

10. Contact Phone/Email

 

 

 

 

 

 

 

 

Section E—Certification

This is to certify that the information contained on this form is complete and correct.

_________________________________________________

_________________________

________________________________

Signature of Owner, Partner, Member, or Executive Officer Title

Business Name

_________________________________________________

_________________________

 

Print name of above signature

Date

 

ERM-14 (Rev. 2/20)

© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.

Page 2 of 2

How to Edit Erm 14 Form Online for Free

It shouldn’t be challenging to get erm 14 form with the help of our PDF editor. Here's how one could successfully prepare your form.

Step 1: Choose the orange "Get Form Now" button on the following page.

Step 2: You will find all of the options that you can use on your template after you have entered the erm 14 form editing page.

To be able to prepare the form, enter the details the program will request you to for each of the next parts:

erm 14 work comp form empty spaces to complete

Include the asked details in the Type of Transaction Columns A, ENTITY 1, Complete Column A on Page, Complete Name of Entity (including, Risk ID, FEIN, Eff, Policy #, Type of Entity (check all that, ¤ Limited Liability Corporation, ¤ Municipality, ¤ Temporary Labor Service ¤ School, ¤ Religious Organization ¤, ¤ For Profit ¤ Not for Profit ¤, ¤ Franchise, Primary Address, Street, City, Telephone Number, Fax Number, and E, mail Address section.

stage 2 to entering details in erm 14 work comp form

Write down any information you may need within the space Contact Name, Mailing Address (if different than, Additional Location, s ERM, 14 © 2002 National Council on, Page 1 of 4, Web Site, and Oct 2003 (1).

Entering details in erm 14 work comp form step 3

The ENTITY 2, Complete Column B on Page, Complete Name of Entity (including, Risk ID, FEIN, Eff, Type of Entity (check all that, ¤ Limited Liability Corporation, ¤ Municipality, Policy #, ¤ Temporary Labor Service ¤ School, ¤ Religious Organization ¤, ¤ For Profit ¤ Not for Profit ¤, ¤ Franchise, Primary Address, Street, City, Telephone Number, Fax Number, E, mail Address, Contact Name, Mailing Address (if different than, Additional Location, s ENTITY 3, Complete Column C on Page, Complete Name of Entity (including, and Web Site area is going to be place to insert the rights and obligations of both sides.

Filling in erm 14 work comp form stage 4

Finalize by checking the next fields and preparing them as required: Risk ID, FEIN, Eff, Type of Entity (check all that, ¤ Limited Liability Corporation, ¤ Municipality, Policy #, ¤ Temporary Labor Service ¤ School, ¤ Religious Organization ¤, ¤ For Profit ¤ Not for Profit ¤, ¤ Franchise, Primary Address, Street, Telephone Number, Contact Name, Fax Number, E, mail Address, City, Web Site, Mailing Address (if different than, Additional Location, s and Section B, Ownership

Entering details in erm 14 work comp form stage 5

Step 3: Once you pick the Done button, your completed document is readily transferable to all of your gadgets. Or, you may send it by using mail.

Step 4: It is better to create copies of the file. You can be sure that we will not share or see your data.

Watch Erm 14 Form Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .