Free PDF - New Jersey


File Size: 7.8 kB
Pages: 2
Date: June 29, 2001
File Format: PDF
State: New Jersey
Category: Workers Compensation
Word Count: 258 Words, 1,960 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.njcrib.com/forms/Form%2016%20NJ.pdf

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Form 16 NJ A
POSTING NOTICE The law requires every insured employer to post and maintain notices naming the company insuring its compensation liability "in a conspicuous place or places in and about the employer's place of business." The form of notice is prescribed by the Commissioner of Insurance and shall be clearly printed on a minimum of 90# index, 8½" by 11" in size. The content and arrangement of items must be consistent with the layout shown below. In accordance with 3:2-1 a duplicate filing must be made before the form is placed in use.

NOTICE

The undersigned employer hereby gives notice that the payment of compensation to employees and their dependents has been secured in accordance with the provisions of the Employer's Liability Insurance Law, Title 34, Chapter 15, Article 5, Revised Statutes New Jersey, by insuring with the ( for the period Beginning . . . . . . . . . . . . . . . . Ending . . . . . . . . . . . . . . . . . . . Employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . In accordance with the above cited law, notice of compliance must be posted and maintained conspicuously in and about the employer's workplaces. ) Insurance Company

Form 16 NJ A

Form 17 NJ AVISO El patron avisa que ha asegurado el pago de compensación a los empleados y sus dependientes, de acuerdo con lo provisto por la ley de responsabilidad de los patrones de seguro para sus empleados. Titulo 34, Capitulo 15, Articulo 5, revision de estatutos del Estado de New Jersey, asegurandolos con. ( por el periodo Comenzando .................................. Terminando ................................................ Patron .................................................................................................................. De acuerdo con la ley mencionada arriba, esta noticia debe ser colocada y mantenida en un lugar visible en todos los lugares de trabajo.
Form 17NJ

) Compañia de Seguro