Form Db-212.3 - Notice Of Election Page 2
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1
2Section 212, Subdivision 4 of the
New York Disability Benefits Law
An executive officer of a corporation who at all times during the period involved owns all
of the issued and outstanding stock of the corporation and holds all of the offices
pursuant to paragraph (e) of section 715 of the business corporation law or two
executive officers of a corporation who at all times during the period involved between
them own all of the issued and outstanding stock of such corporation and hold all such
offices provided, however, that each officer must own at least one share of stock and
who is the executive officer or who are the executive officers of a corporation having
other persons who are employees required to be covered under this article, shall be
deemed to be included in the corporation's disability benefits insurance contract or
covered by a certificate of self-insurance or a plan under section two hundred eleven of
this article, unless the officer or officers elect to be excluded from the coverage of this
article. Such election shall be made by any such corporation filing with the insurance
carrier, or the chair of the workers' compensation board in the case of self insurance,
upon a form prescribed by the chairman, a notice that the corporation elects to exclude
the executive officer or officers of such corporation named in the notice from the
coverage of this article. Such election shall be effective with respect to all policies
issued to such corporation by such insurance carrier as long as it shall continuously
insure the corporation.
Such election shall be final and binding upon the executive
officer or officers named in the notice until revoked by the corporation.
Section 715, Paragraph (e) of the
Business Corporation Law
Any two or more offices may be held by the same person, except the offices of
president and secretary.
When all of the issued and outstanding stock of the
corporation is owned by one person, such person may hold all or any combination of
offices.
DB-212.3 (1-04) Reverse
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