Holly Springs, NC · Wake County
Workers’ Compensation Coverage Affidavit
This affidavit states the workers’ compensation coverage status of people performing permitted work, and is completed by a building permit applicant who is a contractor, owner, or their officer or agent.
- 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 affidavit records whether the people performing work have workers’ compensation insurance, use subcontractors with their own coverage, or have no more than two employees and no subcontractors. The form identifies the building permit number and asks the applicant to select the applicable coverage statement, then sign under oath or affirmation. The Inspection Department may request insurance certificates before issuing the permit or while the permitted work is underway.
Who needs it
A contractor, property owner, or officer or agent applying for a building permit must complete this affidavit about workers’ compensation coverage for the project’s workers and subcontractors.
Why it needs a notary
The applicant signs the statement under oath or affirmation before the notary; the form’s notarial block says it is sworn to and subscribed before the notary.
How to get this notarized
- 1
Download the Affidavit
Get the Workers’ Compensation Coverage Affidavit from the Holly Springs document page.
- 2
Fill In the Form
Enter the building permit number, identify your role, select the coverage statement that applies, and complete the firm and signer details.
- 3
Book an Online Notary
Arrange a session with a commissioned online notary and ask the city about its submission requirements if needed.
- 4
Sign Before the Notary
Sign the affidavit under oath or affirmation during the notarization session.
- 5
Submit to the City
Provide the completed affidavit with your building permit application as directed by Holly Springs.
Preview the form
The blank PDF straight from Holly Springs. 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 get the affidavit notarized?
- Complete the form, then arrange a session with a commissioned online notary. Sign under oath or affirmation before the notary and confirm the city’s submission requirements.
- Do I need to sign the affidavit in front of a notary?
- Yes. The form includes a sworn-to-and-subscribed-before-me block, so the applicant should sign the statement before the notary.
- Is North Carolina remote online notarization available for this form?
- North Carolina’s enacted remote electronic notarization program has not launched. Emergency video notarization requires both the signer and notary to be inside North Carolina and is not remote online notarization.
- What if I am unsure whether the city accepts my notarization?
- Ask Holly Springs about its submission requirements before signing; confirm with the city or town if unsure.
Other forms in Holly Springs
Workers’ Compensation Coverage Affidavit in other Wake County cities
Each city publishes its own version of this form. Pick the city where you’re filing.