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FAQ
Looking for your Helpside W-2?
Workers' Compensation Certificate Request
To request a copy of your workers' compensation certificate, please complete the form below.
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Requester Name
*
Your first and last name
Requester Email or Fax Number
*
Your email or fax number
Requester Phone Number
*
Your phone number
Issued Name
*
Name of the company insured through the Helpside program
Certificate Holder
*
Name of company or party the certificate is to be sent to
Holder Address (Street, City, State and Zip)
*
Address of company or party the certificate is to be sent to
Attn:
Person who's attention the certificate should be sent to
Holder Email or Fax Number
*
Email or fax of company or party the certificate is to be sent to
Additional Info (job site, job number, additional contract requirements, etc.)
If the certificate holder requires anything additional on the certificate, such as specific job listed, or specific wording, please list it here.
If holder has provided a list of insurance requirements, please attach document with this request.
Click or drag a file to this area to upload.
Where would you like the certificate sent? (Be sure to provide an email or fax above for each recipient selected.)
Insured
Certificate Holder
Request Work Comp Certificate