New Jersey Insurance Carrier Or Self-Insured Employer Contact Person Form

• Category: New Jersey Workers Compensation - Official - Miscellaneous
• State: New Jersey
• Control #: NJ-SKU-1720
• Format: PDF

Description

Insurance Carrier Or Self-Insured Employer Contact Person Form The New Jersey Insurance Carrier or Self-Insured Employer Contact Person Form is used by employers who are self-insured or have an insurance carrier that provides workers’ compensation coverage in New Jersey. It is designed to provide contact information for the employer’s designated contact person, including their name, address, phone number, and email address. This form must be completed and signed by the employer and sent to the New Jersey Division of Workers’ Compensation. This form is required for any employer that has an insurance carrier or is self-insured in the state of New Jersey. There are two types of New Jersey Insurance Carrier or Self-Insured Employer Contact Person Form: the New Jersey Insurance Carrier/Self-Insured Employer Contact Person Form (Form DWC-9-E) and the Self-Insured Employer Contact Person Form (Form DWC-9-SI).

The New Jersey Insurance Carrier or Self-Insured Employer Contact Person Form is used by employers who are self-insured or have an insurance carrier that provides workers’ compensation coverage in New Jersey. It is designed to provide contact information for the employer’s designated contact person, including their name, address, phone number, and email address. This form must be completed and signed by the employer and sent to the New Jersey Division of Workers’ Compensation. This form is required for any employer that has an insurance carrier or is self-insured in the state of New Jersey. There are two types of New Jersey Insurance Carrier or Self-Insured Employer Contact Person Form: the New Jersey Insurance Carrier/Self-Insured Employer Contact Person Form (Form DWC-9-E) and the Self-Insured Employer Contact Person Form (Form DWC-9-SI).