Coverage Election By Employee Who Is An Officer Or Member {6B}

6B - COVERAGE ELECTION BY EMPLOYEE WHO IS AN OFFICER OF A CORPORATION OR A MEMBER OF AN LLC. This form is used by employees who are officers of a corporation or members of a limited liability company (LLC) in the state of Connecticut. The purpose of this form is for the employee to make an election regarding their coverage under the Workers' Compensation Act. The employee must indicate whether they want to be excluded from coverage or revoke any previous election of exclusion. This decision is made pursuant to Section 31-275 of the Connecticut General Statutes. The form requires the employee to provide their personal information, including their name, date of birth, street address, city or town, state, and zip code. The exact name and address of the employer (corporation or LLC) must also be provided, along with the employee's position or office held within the company. The employee's signature and the date of the election are required on the form. It also includes a statement affirming that workers' compensation insurance is required for all covered employees under Section 31-284 of the Connecticut General Statutes. It is important to note that the Workers’ Compensation Commission accepts the coverage election form 6B for filing purposes ONLY. The filer of this form is solely responsible for the accuracy of the information contained herein. www.FormsWorkflow.com