Employee Leasing Company Notification {WKC-15784}

WKC-15784 - EMPLOYEE LEASING COMPANY NOTIFICATION OF A CLIENT COVERED UNDER A MASTER POLICY FOR SMALL CLIENTS UNDER S. 102.315(5)(b), WIS. STATS. This form is used by employee leasing companies to notify the Wisconsin Department of Workforce Development (DWD) when they enter into a leasing agreement with a small client that will be covered under a master workers’ compensation insurance policy. The form must be submitted within 30 days of the effective date of the employee leasing agreement. It collects essential information about both the leasing company and the client, including legal names, addresses, federal employer identification numbers, insurance details, nature of the client’s business, number of leased employees, estimated unmodified annual premiums, and payroll classifications. This notification helps the DWD ensure compliance with Chapter 102 of the Wisconsin Statutes, which governs workers’ compensation insurance. www.FormsWorkflow.com