K-WC Form 124 Cancellation of Form K-Wc 123 - Cancellation of Election of Employer to Provide Workers Compensation Coverage for Volunteer Workers - Kansas

Form K-WC124 is a Kansas Department of Labor form also known as the "Cancellation Of Form K-wc 123 - Cancellation Of Election Of Employer To Provide Workers Compensation Coverage For Volunteer Workers". The latest edition of the form was released in March 1, 2014 and is available for digital filing.

Download a PDF version of the Form K-WC124 down below or find it on Kansas Department of Labor Forms website.

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KANSAS DEPARTMENT OF LABOR
www.dol.ks.gov
CANCELLATION OF FORM K-WC 123
K-WC 124 (Rev. 3-14)
MAIL: Division of Workers Compensation
401 SW Topeka Blvd., Suite 2
Topeka, KS 66603-3105
FAX: (785) 296-0025
Cancellation of Election of Employer to Provide
Workers Compensation Coverage for Volunteer Workers
To be processed, ALL entries on this form must be completed. If not completed using
the fillable form feature, entries must be neatly printed in black ink or typewritten. This
form must be signed.
This Cancellation of Election is effective upon receipt by the Kansas Division of Workers
Compensation.
To the Kansas Division of Workers Compensation, you are hereby notified that:
Employer name: _____________________________________________________________________________
Address: ___________________________________________________________________________________
__________________________________________________________________________________________
Email: _____________________________________________________________________________________
hereby cancels its previous election to provide workers compensation coverage for volunteers within
the provisions of the Kansas Workers Compensation Act.
Signature of employer or authorized representative
Title
Date
DIVISION OF WORKERS COMPENSATION
401 SW Topeka Blvd., Suite 2, Topeka, KS 66603-3105 • Phone (785) 296-4000 • Fax (785) 296-0025
KANSAS DEPARTMENT OF LABOR
www.dol.ks.gov
CANCELLATION OF FORM K-WC 123
K-WC 124 (Rev. 3-14)
MAIL: Division of Workers Compensation
401 SW Topeka Blvd., Suite 2
Topeka, KS 66603-3105
FAX: (785) 296-0025
Cancellation of Election of Employer to Provide
Workers Compensation Coverage for Volunteer Workers
To be processed, ALL entries on this form must be completed. If not completed using
the fillable form feature, entries must be neatly printed in black ink or typewritten. This
form must be signed.
This Cancellation of Election is effective upon receipt by the Kansas Division of Workers
Compensation.
To the Kansas Division of Workers Compensation, you are hereby notified that:
Employer name: _____________________________________________________________________________
Address: ___________________________________________________________________________________
__________________________________________________________________________________________
Email: _____________________________________________________________________________________
hereby cancels its previous election to provide workers compensation coverage for volunteers within
the provisions of the Kansas Workers Compensation Act.
Signature of employer or authorized representative
Title
Date
DIVISION OF WORKERS COMPENSATION
401 SW Topeka Blvd., Suite 2, Topeka, KS 66603-3105 • Phone (785) 296-4000 • Fax (785) 296-0025

Download K-WC Form 124 Cancellation of Form K-Wc 123 - Cancellation of Election of Employer to Provide Workers Compensation Coverage for Volunteer Workers - Kansas

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