New York State Workers Compensation Exemption Form - (print name of authorized representative. Web liability in accordance with the workers' compensation law and all other new york state laws. Web information on and copies of this form are available from any district office of the workers’ compensation board or from. Web nys workers' compensation insurance coverage. Web the application will be processed in the order received and a certificate of attestation of exemption will be mailed to the applicant.
Web the application will be processed in the order received and a certificate of attestation of exemption will be mailed to the applicant. Web liability in accordance with the workers' compensation law and all other new york state laws. (print name of authorized representative. Web information on and copies of this form are available from any district office of the workers’ compensation board or from. Web nys workers' compensation insurance coverage.