Application For Certificate Of Non-Coverage {AR-A}

Form AR-A - APPLICATION FOR CERTIFICATE OF NON-COVERAGE. This form is used by the Arkansas Workers’ Compensation Commission for individuals or entities seeking exemption from workers' compensation insurance requirements. The form outlines Arkansas law regarding workers' compensation insurance, including requirements and penalties for non-compliance. It requires applicant information such as name, social security number, signature, and business details. Depending on the answers provided, the form is either submitted to the insurance agent for processing along with the workers' compensation policy application or directly to the Arkansas Workers’ Compensation Commission. It also includes an affidavit for individuals electing to be excluded from mandatory workers' compensation insurance coverage and provides a legal disclaimer about the consequences of providing false information. www.FormsWorkflow.com