This online application is to REVOKE a current Certificate of Election to be Exempt from Florida Workers’ Compensation Law (exemption). If you are wanting to exclude an officer of a corporation or a member of a limited liability company from the workers' compensation insurance laws, click here for more information on Exemptions. www.myfloridacfo.com/division/wc/employer/exemptions
A Revocation of Election to be Exempt shall only be filed by the same person named on the Certificate of Election to be Exempt or by a corporate officer of the business named on the Certificate of Election to be Exempt and listed as a corporate officer with the Department of State, Division of Corporations.
THIS REVOCATION OF ELECTION TO BE EXEMPT APPLIES ONLY TO THE PERSON NAMED ON THIS FORM AND ONLY TO THE CORPORATION/LLC THAT IS LISTED IN THIS SECTION.
PURSUANT TO SECTION 440.05 (3) FLORIDA STATUTES, UPON FILING A NOTICE OF REVOCATION, IF YOU ARE AN OFFICER WHO IS A SUBCONTRACTOR OR AN OFFICER OF A CORPORATE SUBCONTRACTOR, YOU MUST NOTIFY YOUR CONTRACTOR THAT YOU HAVE REVOKED YOUR EXEMPTION.
PURSUANT TO SECTION 440.05(3), FLORIDA STATUTES, UPON WRITTEN REQUEST FROM A WORKERS’ COMPENSATION CARRIER, THE DEPARTMENT SHALL SEND THEREAFTER AN ELECTRONIC NOTIFICATION TO THE CARRIER IDENTIFYING EACH OF ITS POLICYHOLDERS FOR WHICH A NOTICE OF REVOCATION TO BE EXEMPT HAS BEEN RECEIVED.