New Hampshire > Workers Comp > Self-Insurance
Parent Company Agreement - New Hampshire
| Parent Company Agreement Form. This is a New Hampshire form and can be used in Self-Insurance Workers Comp . |
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State of New Hampshire Department of Labor David M. Wihby Acting Commissioner of Labor State Office Park South 95 Pleasant Street Concord, NH 03301 603/271-3176 TDD Access: Relay NH 1-800-735-2964 FAX: 603/271-6149 http://www.nh.gov/labor PARENT COMPANY AGREEMENT THIS IS TO CERTIFY that Name of Corporation Home Address agrees to and does guarantee the direct payment of employee-leasing company benefits in accordance with the employee-leasing law of New Hampshire, RSA 277-B, as amended and all rules and regulations promulgated thereunder, of (Name of Corporation), of (Home Address), being a subsidiary of the aforesaid parent company, an employer and an employee-leasing company in the said state. It is further agreed that the liability of the parent corporation shall be that of the employee-leasing company and that upon default of the employee-leasing company the labor commissioner of the said state may demand of the said guarantor payment of the said benefits in manner prescribed by him. This agreement shall not be terminated without a sixty-day prior written notice to the said commissioner. Written notice of such termination shall not relieve the parent corporation of its liability under this agreement for obligations that occurred prior to the effective date of such termination. Dated: _______________ Signature: __________________________________ Title: ______________________________________ State of __________________ County of ________________ On this date, the person named above, known to me (or satisfactorily proven), personally appeared before me and swore to the truth of and executed this document for its intended purposes. __________________________________Notary Public / Justice of the Peace My commission expires on: (ELPI) Parent Company Agreement American LegalNet, Inc. www.FormsWorkFlow.com
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