Ballwin, MO · St. Louis County
Affidavit of Exemption for Workers’ Compensation Insurance
This affidavit lets a construction contractor state why the business is exempt from workers’ compensation insurance when applying for a city or county occupational or business license.
- 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
The form asks the contractor to identify the business and select an exemption basis, such as having no employees or qualifying for a corporate exemption. The form says contractors applying for an occupational or business license must file it when they lack proof of workers’ compensation coverage; without proof or the completed affidavit, the license may be denied. It also includes guidance about employee definitions, statutory employment, and penalties for false information.
Who needs it
A construction contractor applying for a Ballwin occupational or business license needs this affidavit if the contractor does not have proof of workers’ compensation insurance coverage.
How to get this notarized
- 1
Download The Form
Download the Affidavit of Exemption for Workers’ Compensation Insurance.
- 2
Complete The Affidavit
Enter the affiant and business details, select the applicable exemption reason, and review the form’s guidance.
- 3
Book An Online Notary
Arrange a remote notarization with a commissioned online notary.
- 4
Sign On Video
Appear for the online notary session and sign and swear to the affidavit as directed.
- 5
Submit To The City
Submit the notarized affidavit with your occupational or business license application.
Preview the form
The blank PDF straight from Ballwin. 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 this workers’ compensation exemption affidavit?
- Enter your information and business name, check the applicable exemption reason, provide requested dates, and review the form’s guidance. Sign and swear to it before a notary.
- Do I need to file this affidavit with my Ballwin license application?
- The form says a contractor applying for an occupational or business license must file it if the contractor does not have proof of workers’ compensation coverage.
- Can I sign the affidavit with a commissioned online notary?
- Missouri authorizes remote online notarization for its own notaries. Ask the city how it accepts a remotely notarized affidavit; confirm with the city or town if unsure.
- What happens if I do not provide proof of coverage or this affidavit?
- The form says the contractor shall be denied the business license until the contractor obtains a certificate of insurance.
Affidavit of Exemption for Workers’ Compensation Insurance in other Missouri cities
Each city publishes its own version of this form. Pick the city where you’re filing.