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

What Is K-WC Form 124?

This is a legal form that was released by the Kansas Department of Labor - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2014;
  • The latest edition provided by the Kansas Department of Labor;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of K-WC Form 124 by clicking the link below or browse more documents and templates provided by the Kansas Department of Labor.

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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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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