NY C-105.31 2004-2025 free printable template
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State of New York WORKERS' COMPENSATION BOARD THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION. NOTICE OF ELECTION OF A MUNICIPAL CORPORATION OR OTHER POLITICAL SUBDIVISION
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How to fill out NY C-10531
How to fill out NY C-105.31
01
Obtain the NY C-105.31 form from the New York State Workers' Compensation Board website or your employer.
02
Fill in your personal information including your name, address, and Social Security number.
03
Provide information about your employer, including their name, address, and workers' compensation insurance carrier.
04
Describe the nature of your injury or illness, including the date it occurred and any related medical treatments received.
05
Sign and date the form to certify that the information you provided is accurate.
06
Submit the completed form to your employer and keep a copy for your records.
Who needs NY C-105.31?
01
Employees in New York who have been injured on the job or have a work-related illness need to fill out NY C-105.31.
02
Employers may also need this form for reporting purposes related to workers' compensation claims.
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What is NY C-105.31?
NY C-105.31 is a form used in New York State for reporting certain information related to workers' compensation insurance coverage.
Who is required to file NY C-105.31?
Employers who are required to have workers' compensation insurance in New York State must file NY C-105.31.
How to fill out NY C-105.31?
To fill out NY C-105.31, employers need to provide information such as their business name, address, type of business, and the details of their workers' compensation insurance policy.
What is the purpose of NY C-105.31?
The purpose of NY C-105.31 is to provide official documentation of workers' compensation coverage to the New York State Workers' Compensation Board.
What information must be reported on NY C-105.31?
The information reported on NY C-105.31 includes the employer's identification, insurance carrier details, policy number, effective dates, and the nature of the business.
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