Erm 14 Forms
This form 2 pages is used to detail the ownership of an entity or entities.
Erm 14 forms. Minnesota statistical plan manual. A comprehensive list of wcrb forms are provided below. Its designed for employers policyholders insurance agents and brokers who have concerns and questions about accuracy of their workers compensation experience modification rate the erm 14 and the emr calculation process. If you need a form or document its here.
This is a special service our company provides. We will be adding more online training modules throughout the coming months and we will announce these on our linkedin page as well as in our newsletters. Effective 01 dec 2003. Erm 14 form is to be submitted for reporting changes in ownership mergers consolidations or a combination of entities.
To see forms for a specific organization type select the show me links below show me agent forms. Erm 14 formconfidential request for ownership information. Please go to our experience rating ownership submission tool with esignature for easier completion of the erm 14 form. You hereby certify that you are either 1 the employer subject to this ownership form or 2 the current carrier of record or producer of record for the employer organization employer.
Fort lauderdale office 5900 hiatus road tamarac fl 33321 ph 954 724 7014. Ma erm form confidential request for information updated form as of april 1 2017. We are glad you stopped by. Keeping you informed is integral to the way we work together to make workers comp effective and easy.
Updated in july 2018 the minnesota statistical plan manual contains instructions for submitting unit statistical reports usrs which must be filed for every workers compensation and employers liability policy written in minnesota. Louisiana office standard lines brokerage of la 3321 hessmer ave.
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