R 408.41b Notice of election to be excluded as employees under act.

Rule 11b. (1) A notice of election to be excluded under section 161(5) of the act, MCL 418.161, must be reported to the agency on form WC-337, or its electronic equivalent, notice of exclusion. The employer shall have the notice notarized. If the employer is a partnership or corporation, then the notice must state the names of all the partners or corporate officers. If the employer is doing business under an assumed name, then the notice must state the assumed name and each Michigan location covered. (2) The employer shall certify that the employees signing the exclusion comprise all of the employees of the employer. The employer shall further certify that all employees are eligible to be excluded under section 161(2) or (3) of the act, MCL 418.161. Each employee shall furnish his or her social security number and certify that the employee voluntarily signed the election to be excluded. The employer shall furnish its federal identification number. The employer shall furnish each employee with a copy of the completed exclusion form before filing the form with the agency. The exclusion shall become effective upon receipt of the notice of exclusion by the agency.