Client Affidavit Of Zero Wages

2 min. readlast update: 09.12.2023

Here, the undersigned owner of the client's company will certify that the client’s company is reporting ZERO WAGES for the pay period noted below - towards the end of the form.

You can find our "Client Affidavit of Zero Wages" form at the top menu bar, under Resources - Client Forms, scroll down, then click on the "Client Affidavit of Zero Wages" button. 


In this section, the client company is affirming to OCMI Workers Comp that it has NOT performed any of the following actions, directly or indirectly, during the Pay Period listed below: 

Employed and/or paid in any manner, any person acting as an employee and has ZERO payroll to report.

Performed any work, guaranteeing payment or any compensation to any person or employees.

Performed any work for OCMI Workers Comp certificate holders, or implied workers' compensation coverage under the OCMI Workers Comp Professional Employer Service Agreement.

The client company also agrees to release and hold harmless OCMI Workers Comp and their respective affiliated companies, officers, directors, agents, employees and insurance carriers from, and to indemnify each of them against any and all liabilities, obligations, contractual or otherwise, claims and causes of action for compensation, injury, death, illness, or employer's liability arising out of or in connection with or arising during the payment period noted.

Under the heading "Inactive Zero Wages Pay Period" - you will be asked to enter the start and end date of the inactive period, the name of the client company, the client's name and the client's email address to certify that the information submitted in the affidavit is true and accurate.

Once all the information has been completed, click on the "Submit your request" button.


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