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Insurance Carrier Forms

Welcome to the State of New Hampshire's Insurance Carrier Forms Download. We are in the process of redesigning this web site and migrating to the State's NH.Gov server. The online application for the download of certain workers' compensation forms is not yet available on the new site. In the interim we request you follow the process below. Thank you for your patience.

The following insurance carrier forms are only available to licensed and approved Workers' Compensation carriers. Carriers need to contact the NH Department of Labor for to obtain these forms. Please provide an email address, the name of your company and specify which form or forms you are requesting.

  • Exclusion of Executive Officers or Members
  • Notice of Workers' Compensation Insurance Coverage
  • New Hampshire Workers' Compensation Insurance Coverage Reinstatement Notice
  • New Hampshire Workers' Compensation Insurance Coverage Termination Notice
  • Supplemental Notice of Information Regarding Workers' Compensation Insurance Coverage
  • Notice of Compliance
  • Aviso De La Conformidad (Notice of Compliance in Spanish)

Contact Information:
NH Department of Labor
Coverage Unit
Phone: (603) 271-2563
email: NHCoverage@labor.state.nh.us

For related forms that do not require special access or approval:
Forms and Publications
Workers' Compensation Division Forms

 


New Hampshire Department of Labor  |  
95 Pleasant Street  |  Concord, NH 03301
Telephone: 603-271-3176  |  
Hours of Operation: 8am - 4:30pm M-F