Form Wc 40 - Independent Contractor - Affidavit Of Exemption

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TO:
Independent Contractor
FROM:
Workers’ Compensation/Compliance Section
SUBJECT:
WC40/Affidavit of Exemption
ALL QUESTIONS MUST BE COMPLETED on the attached affidavit (WC40). Failure to
comply will result in automat ic denial of exemption.
ALL PARTNERS must provide a signature and social security number.
They are all required to sign and the bottom to be notarized.
Your request will be accepted or denied the day of receipt.
The executed affidavit is to be mailed to:
State of Alabama
DIR/WC/Compliance Section
649 Monroe Street
Montgomery, AL 36131
WC40
(04/2002)

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