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Get Form Rejection Compensation 2010-2024

Ficers, corporate members and members of board of directors are permitted to reject coverage under a WV workers’ compensation policy. You are attesting that in your capacity as an owner, officer, or member of a board of directors for the company described below, you are giving your workers’ compensation carrier notice to: Be excluded from workers’ compensation coverage on your workers’ compensation policy. Be reinstated for workers’ compensation coverage from which you were previously .

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