Employees Affidavit And Waiver Of Workers Compensation Benefits And Statement Of Religious Sect {LIBC-14B}

LIBC-14B - EMPLOYEE’S AFFIDAVIT AND WAIVER OF WORKERS’ COMPENSATION BENEFITS AND STATEMENT OF RELIGIOUS SECT. This form is used in Pennsylvania for individuals who are members of a religious sect or division whose tenets oppose accepting workers' compensation benefits. The form includes an affidavit where the employee affirms their adherence to the sect's teachings and voluntarily waives their rights to workers' compensation benefits. Additionally, it includes a statement from the religious sect leader confirming the individual's membership and the sect's opposition to accepting such benefits. The form also warns against providing misleading or incomplete information, as it could result in penalties under the Pennsylvania Workers' Compensation Act and related statutes. www.FormsWorkflow.com