NY C-105.2 2017-2025 free printable template
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CERTIFICATE OF NYS WORKERS\' COMPENSATION INSURANCE COVERAGE 1a. Legal Name & Address of Insured (use street address only)1b. Business Telephone Number of Insured1c. NYS Unemployment Insurance Employer
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How to fill out c 105 form
How to fill out NY C-105.2
01
Gather required information: Collect necessary documents, including payment details, employer identification numbers, and gross wages.
02
Download the NY C-105.2 form: Access the NY State Workers' Compensation Board website to obtain the form.
03
Complete the employee information section: Fill in the employee’s name, address, and social security number.
04
Fill in the employer information section: Provide the employer's name, address, and Workers' Compensation insurance information.
05
Detail the wages: Include details of the employee's wages, including gross earnings for the reporting period.
06
Indicate any deductions: If applicable, mention any deductions taken from the employee’s wages.
07
Review the form: Double-check all the entered information for accuracy and completeness.
08
Submit the form: Follow the instructions for submitting the form either electronically or via mail.
Who needs NY C-105.2?
01
Employers in New York who have workers' compensation insurance policies are required to fill out NY C-105.2.
02
Businesses that have employees and pay wages must file this form to report payroll information and any associated claims.
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What is NY C-105.2?
NY C-105.2 is a form used by New York employers to report on the status of their workers' compensation insurance coverage.
Who is required to file NY C-105.2?
All New York employers who are required to have workers' compensation insurance must file NY C-105.2.
How to fill out NY C-105.2?
To fill out NY C-105.2, employers should provide details such as their business information, workers' compensation insurance carrier details, and the coverage period. Instructions are usually included with the form.
What is the purpose of NY C-105.2?
The purpose of NY C-105.2 is to ensure that employers are in compliance with New York's workers' compensation law and to provide proof of insurance coverage.
What information must be reported on NY C-105.2?
Information that must be reported on NY C-105.2 includes the employer's name, address, insurance carrier's name, policy number, and the effective dates of coverage.
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