Oxford, CT · New Haven County
Proof of Workers’ Compensation Coverage
This Oxford building-permit form records how a property owner or sole proprietor acting as general contractor will provide workers’ compensation coverage for workers on the construction project.
At a glance
- Issued by
- City of Oxford · Oxford, New Haven County, Connecticut
- Notarization
- Required: sign this form in front of a notary before filing it.
- Official source
- oxford-ct.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
- 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
Oxford uses this form when a property owner or sole proprietor applies for a building permit and will act as the general contractor or principal employer. The applicant checks the applicable option to state whether they will submit proof of coverage for employees or require proof of coverage from each contractor, subcontractor, or other worker before work begins. The affidavit applies to the option where the applicant will not personally submit proof.
Who needs it
A property owner or sole proprietor applying for an Oxford building permit and acting as general contractor or principal employer should complete the applicable section.
Why it needs a notary
The form has a subscribed-and-sworn jurat for the affidavit; the owner or sole proprietor signing that affidavit must sign before a notary public or Superior Court commissioner.
How to get this notarized
- 1
Download the Form
Get Oxford’s Proof of Workers’ Compensation Coverage form.
- 2
Fill In the Form
Enter applicant and property details, then check the option that applies to your role and coverage plan.
- 3
Book an Online Notary
If completing the affidavit, book a remote notarization appointment with a commissioned online notary.
- 4
- 5
Submit to the City
Include the completed form with your Oxford building-permit application.
Preview the form
The blank PDF straight from Oxford. 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 applicable option, and complete the affidavit if you will not personally submit proof of coverage. Sign the affidavit before a notary public or Superior Court commissioner.
- Do I need to notarize this form?
- The form asks applicants using the affidavit option to sign it before a notary public or Superior Court commissioner. The other listed options do not include an affidavit jurat.
- Can I sign the affidavit with a commissioned online notary?
- Connecticut authorizes remote online notarization for its own notaries under Public Act 23-28, effective October 1, 2023. Connecticut law also recognizes certain notarial acts performed outside the state. Confirm with the town clerk if unsure.
- What happens after the form is notarized?
- Submit the completed form as part of your Oxford building-permit application. The form says the applicant must provide proof of coverage or attest to requiring proof from workers before they begin work.
Proof of Workers’ Compensation Coverage in other New Haven County cities
Each city publishes its own version of this form. Pick the city where you’re filing.