Form 105 (2) Download Fillable PDF or Fill Online Application for
C-105.2 Form. Disability insurance (submit one from this list): Assignment (transfer) of policy interest agreement.
Contact your insurance carrier or licensed nys insurance agent for these forms. Web if you maintain workers' compensation and disability insurance coverage. Carriers and their licensed agents may email the board at certificates@wcb.ny.gov to obtain controlled forms not available on this website. (print name of authorized representative or licensed agent of insurance carrier) title: Carriers and their licensed agents may email the board at certificates@wcb.ny.gov to obtain controlled forms not available on this website. Insurance brokers are not authorized to issue it. Contact your insurance carrier or licensed nys insurance agent for these forms. Carriers and their licensed agents may email the board at certificates@wcb.ny.gov to obtain controlled forms not available on this website. This form must be submitted by the original due date of the return, and will extend the deadline by six months. Form c 105 2 is an irs form that must be filed in order to request an extension of time to file your company's income tax return.
Carriers and their licensed agents may email the board at certificates@wcb.ny.gov to obtain controlled forms not available on this website. Carriers and their licensed agents may email the board at certificates@wcb.ny.gov to obtain controlled forms not available on this website. Insurance brokers are not authorized to issue it. This form must be submitted by the original due date of the return, and will extend the deadline by six months. (print name of authorized representative or licensed agent of insurance carrier) title: Workers' compensation (submit one from this list): Contact your insurance carrier or licensed nys insurance agent for these forms. Disability insurance (submit one from this list): New york state agency's request for reimbursement. Carriers and their licensed agents may email the board at certificates@wcb.ny.gov to obtain controlled forms not available on this website. Carriers and their licensed agents may email the board at certificates@wcb.ny.gov to obtain controlled forms not available on this website.
