Application For Or Request To Cancel Elective Coverage {BWC-7613}

BWC-7613 -- APPLICATION FOR OR REQUEST TO CANCEL ELECTIVE COVERAGE. All employers with one or more employees must carry workers’ compensation coverage. It’s the law. However, Ohio law makes coverage elective for owners or ministers in one of the following categories: sole proprietor; partnership; limited liability company acting as a sole proprietor; limited liability company acting as a partnership; family farm corporate officers; individual incorporated as a corporation; and ordained or associate ministers of a religious organization. These individuals may cover themselves by submitting this form. Elective coverage is effective the date BWC receives the application and will remain in effect until you request to cancel the coverage. You must complete an additional application for elective coverage to cover owners or ministers you wish to add at a later date. Remember, if you choose not to cover yourself and you are injured at work, BWC will not provide coverage, and other insurance may not cover your work-related disability or medical bills. www.FormsWorkflow.com