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Workers Comp Affidavit
"I need a Workers Comp Affidavit for my construction company operating in New South Wales and Victoria, with 150 employees and multiple ongoing project sites, to be submitted for a government tender by March 2025."
1. Affiant Information: Identifies the person making the affidavit, including their full name, position, and authority to make declarations on behalf of the business
2. Business Details: Essential information about the business including legal name, ABN, business structure, and principal place of business
3. Insurance Coverage Declaration: Detailed statement of current workers' compensation insurance coverage, including policy numbers and dates
4. Employee Information: Declaration of the number of employees and total payroll amount
5. Compliance Statement: Affirmation of compliance with relevant workers' compensation laws and regulations
6. Verification: Formal statement verifying that all information provided is true and correct to the best of the affiant's knowledge
7. Execution: Signature block with date and place of execution, witness details, and proper attestation
1. Interstate Operations: Required when the business operates across multiple states or territories, detailing coverage in each jurisdiction
2. Contractor Statement: Needed when the business employs contractors, detailing their coverage arrangements
3. Claims History: May be required to declare any previous workers' compensation claims or incidents
4. Special Risk Categories: Required for businesses operating in high-risk industries or with special insurance arrangements
5. Self-Insurance Declaration: Needed if the business is self-insured rather than having commercial insurance
1. Schedule A - Certificate of Currency: Copy of current workers' compensation insurance certificate
2. Schedule B - Employer Registration: Evidence of registration as an employer with relevant workers' compensation authority
3. Schedule C - Payment History: Proof of up-to-date premium payments
4. Schedule D - Risk Assessment: Workplace risk assessment documentation if required by the relevant authority
5. Schedule E - Interstate Certificates: Certificates of currency for other states/territories where applicable
Authors
Workers Compensation Insurance
Certificate of Currency
Employee
Contractor
Deemed Worker
Workers Compensation Authority
Policy Period
Premium
Payroll
Coverage
Policy Number
Work-Related Injury
Work-Related Illness
Insurance Provider
Principal Place of Business
Interstate Operation
Self-Insurance
Statutory Declaration
Commissioner for Declarations
Workplace
Business Activity
High-Risk Work
Insurance Limit
Compliance Period
Average Weekly Earnings
Workers Compensation Claim
Policy Excess
Return to Work Program
Business Details
Insurance Coverage
Employee Information
Payroll Declaration
Interstate Operations
Compliance Statement
Claims History
Risk Management
Contractor Management
Insurance Policy Details
Premium Payment Status
Return to Work Programs
Declaration of Truth
Witness Attestation
Supporting Documentation
Statutory Compliance
Regulatory Reporting
Insurance Currency
Legal Jurisdiction
Construction
Manufacturing
Mining
Healthcare
Retail
Hospitality
Professional Services
Transport and Logistics
Agriculture
Education
Technology
Industrial Services
Real Estate
Financial Services
Human Resources
Legal
Compliance
Risk Management
Operations
Finance
Workplace Health and Safety
Procurement
Administration
Executive Leadership
Chief Executive Officer
Managing Director
Human Resources Manager
Compliance Officer
Risk Manager
Operations Manager
Finance Director
Legal Counsel
Workplace Health and Safety Manager
Procurement Manager
Contract Manager
Business Development Manager
Company Secretary
Facilities Manager
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