Professional Employer Organization Client Relationship Notification {BWC-8003}

BWC-8003 / UA-3 - PROFESSIONAL EMPLOYER ORGANIZATION CLIENT RELATIONSHIP NOTIFICATION. Use this form to notify BWC of a new client, change of relationship with a current client or termination of a client. BWC must receive new contract and termination notifications within 30 days of the effective date of the contract or termination. Notice: Pursuant to Ohio Administrative Code 4123-17-15.1, if BWC is not notified within the required time frame, BWC will recognize the date the UA-3 is received as the effective date. For each occurrence that BWC is not notified timely, a late fee will be assessed. Important: If you fax or mail the form to BWC, be sure to sign and date the form. BWC cannot process it without a signature. www.FormsWorkflow.com