Md Wcc Form Ic 02 PDF Details

In navigating the intricacies of state business operations, sole proprietors in Maryland face numerous regulatory requirements, one of which involves the management of workers' compensation. Central to this obligated foresight is the Workers’ Compensation Commission Sole Proprietor’s Status as a Covered Employee Form, known colloquially as the MD WCC IC 02. This form serves as a declaration by the sole proprietor regarding their status under the workers' compensation laws of Maryland, specifically under § 9-227 of the Labor and Employment Article of the Annotated Code of Maryland. By completing this form, sole proprietors communicate to the Maryland Workers' Compensation Commission whether they have elected to be considered as covered employees, thereby availing themselves of workers' compensation insurance, or if they have chosen to waive this coverage. The decision to elect into or out of coverage is a significant one, impacting not only the proprietor's legal obligations but also their eligibility for claims in the event of a workplace injury. Adequate completion of the form involves affirming the sole proprietor’s decision regarding worker’s compensation coverage, a critical step for those navigating the dual roles of business ownership and personal employment within their enterprise. This declaration, substantiated under penalty of perjury, underscores the importance of accurate representation to the commission, facilitating compliance and ensuring legal safeguards for the business and its potential employees.

QuestionAnswer
Form NameMd Wcc Form Ic 02
Form Length1 pages
Fillable?Yes
Fillable fields11
Avg. time to fill out2 min 27 sec
Other namesmd wcc form, md wcc ic form, md ic 02 form, maryland state sole proprietor

Form Preview Example

WORKERS' COMPENSATION COMMISSION

SOLE PROPRIETOR’S STATUS AS A COVERED EMPLOYEE FORM

I hereby represent to the Maryland Workers’ Compensation Commission that I am a sole proprietor doing business in and about the State of Maryland, and that on the date set forth below my signature, under the penalty of perjury, the following checked box represents my status as a covered employee.

Check all that apply:

I have elected to become a covered employee under § 9-227 of the Labor and Employment Article, Annotated Code of Maryland, and have submitted the requisite Inclusion form (IC-

15R) with the Workers’ Compensation Commission.

I have not elected to become a covered employee under § 9-227 of the Labor and Employment Article, Annotated Code of Maryland.

I understand that if I were to hire an employee(s), I must obtain workers’ compensation insurance for the employee(s).

Name of Sole Proprietor:

Social Security Number or Federal

Employer Identification Number (FEIN)

Address:

Street

 

 

City

State

Zip Code

I AFFIRM UNDER THE PENALTY OF PERJURY THAT THE FOREGOING INFORMATION IS TRUE

TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF FOR THE FOLLOWING PERIOD:

 

THROUGH

.

 

 

 

 

(Effective date)

(Expiration date)

Signature

Date

10 East Baltimore Street w Baltimore, Maryland 21202-1641

410-864-5100Email:info@wcc.state.md.usWeb:http://www.wcc.state.md.us

MD WCC Form IC-02 (12/2015)

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Our PDF editor which you'll use was developed by our leading programmers. You may prepare the ic 02 form immediately and conveniently applying our software. Just keep up with this particular instruction to begin with.

Step 1: Press the orange button "Get Form Here" on the following web page.

Step 2: Now it's easy to alter the ic 02. Our multifunctional toolbar enables you to include, delete, customize, and highlight text or perhaps conduct similar commands.

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completing maryland sole proprietor step 1

Write the necessary details in the THROUGH, Effective, date Expiration, date Signature, Date, and M, DW, CC, FormIC field.

maryland sole proprietor THROUGH, Effectivedate, Expirationdate, Signature, Date, and MDWCCFormIC fields to fill out

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