Consent To NYS WCB Jurisdiction For Non-NY Carriers (3C Coverage) {C-105.11} | Pdf Fpdf Doc Docx | New York

 New York   Workers Compensation 
Consent To NYS WCB Jurisdiction For Non-NY Carriers (3C Coverage) {C-105.11} | Pdf Fpdf Doc Docx | New York

Last updated: 1/26/2024

Consent To NYS WCB Jurisdiction For Non-NY Carriers (3C Coverage) {C-105.11}

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Description

C-105.11 - CONSENT TO NYS WORKERS' COMPENSATION BOARD JURISDICTION FOR NON-NEW YORK LICENSED CARRIERS (3C COVERAGE). This form is filed when an insurance company not authorized by NYS Insurance Department to write workers' compensation and employers' liability insurance issues policy to employer not required to have a full statutory New York policy and New York is listed in Item 3C of the Information Page. www.FormsWorkflow.com

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