Sherman, CT · Fairfield County
Workers’ Compensation Coverage Proof and Affidavit
This form records a property owner’s or sole proprietor’s workers’ compensation coverage plan when applying for a building permit and acting as general contractor or principal employer.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
Sherman’s building permit form is for a property owner or sole proprietor who will act as general contractor or principal employer on a construction project. The applicant checks the applicable statement about submitting proof of workers’ compensation coverage for employees, or completes the affidavit promising to require proof from contractors, subcontractors, and other workers. The form directs applicants to sign the affidavit before a notary public or Commissioner of the Superior Court.
Who needs it
A property owner or sole proprietor applying for a building permit who will act as general contractor or principal employer for work at the property needs this form.
Why it needs a notary
The affidavit carries a subscribed-and-sworn jurat; the owner or sole proprietor applicant signs it before a notary public or Commissioner of the Superior Court.
How to get this notarized
- 1
Download The Form
Download the Workers’ Compensation Coverage Proof and Affidavit form for the Sherman building permit application.
- 2
Fill In Applicant Details
Enter the applicant’s name and property location, then check the statement that applies to the owner or sole proprietor.
- 3
Book An Online Notary
If completing the affidavit, book a commissioned online notary and confirm the building department accepts remote notarization.
- 4
Sign On Video
Sign the affidavit during the online notarization so the notary can complete the jurat.
- 5
Submit To The City
Submit the completed form with your building permit application according to the building department’s instructions.
Preview the form
The blank PDF straight from Sherman. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the workers’ compensation form?
- Enter the applicant and property information, check the statement that applies, and complete the affidavit if you will require proof of coverage from workers. Sign the affidavit before a notary or Commissioner of the Superior Court.
- Do I need to notarize the entire form?
- The form specifically directs the applicant to sign the affidavit in the presence of a notary public or Commissioner of the Superior Court. Follow the form’s instructions for the other signature section.
- Can I sign the affidavit with an online notary?
- Connecticut authorizes its notaries to perform remote online notarizations under Public Act 23-28, effective October 1, 2023. Ask the Sherman building department whether it accepts this remotely notarized affidavit.
- Where do I submit the completed form?
- The form is for use when applying for a building permit. Follow the Sherman building department’s submission instructions; confirm with the town clerk if unsure.
Other forms in Sherman
Workers’ Compensation Coverage Proof and Affidavit in other Fairfield County cities
Each city publishes its own version of this form. Pick the city where you’re filing.