If your business is an out of state corporation, you are not subject to the workers' compensation laws of California unless you have employees who reside in California.
Box A or B: If you have employees who reside in California, check “B” below; if not check “A”.
Applicants: Box B also applies to applicants for a permit or certificate who do not now have employees, but will employ workers upon commencement of operations.
Certificate of coverage: The Commission will not issue or reinstate a permit or certificate until it receives the certificate of coverage.
| Question | Answer |
|---|---|
| Form Name | Form TL 706-K |
| Form Length | 1 page |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 3 min |
| Edition | 09/2018 |
| Issuing agency | Public Utilities Commission of the State of California |
| Who signs | Applicant(s) |
| Matches the agency's file | Yes, checked October 1, 2026 |
| Other names | TL 706-K, TL706-K, TL706K, TL 706K, 706K, Workers' Compensation Declaration Form |
| Official source | Form TL 706-K (Rev 09/2018), Public Utilities Commission of the State of California |
Form Tl706 K isn’t the one you’re looking for?