Raleigh, NC · Wake County
Workers’ Compensation Exemption Certification
This certification is for Raleigh contractors with fewer than three workers and no workers’ compensation insurance coverage who claim an exemption and submit the form to the City.
- 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
Raleigh requires contractors to complete this form to claim a workers’ compensation exemption when they have fewer than three workers and no coverage through an insurance company. The contractor identifies their business and whether they are a licensed or unlicensed general contractor, then certifies their exemption and related responsibilities. The form says to email the completed certification to the City’s field services address.
Who needs it
Raleigh contractors with fewer than three workers and no workers’ compensation coverage through an insurance company use this form to claim an exemption.
Why it needs a notary
The form has a sworn-to-and-subscribed jurat; the licensed or unlicensed general contractor signs before the notary, who completes the notary and commission-expiration fields.
How to get this notarized
- 1
Download the Certification
Get the Workers’ Compensation Exemption Certification from the City of Raleigh.
- 2
Fill In the Contractor Information
Enter the business and contact details, then select the applicable licensed or unlicensed contractor status.
- 3
Book an Online Notary
Arrange a session with a commissioned online notary and have identification ready.
- 4
Sign on Video
Sign the certification before the notary, who completes the sworn-to-and-subscribed jurat.
- 5
Submit to the City
Email the completed certification to [email protected].
Preview the form
The blank PDF straight from Raleigh. 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 and submit this certification?
- Fill in the contractor information, select the applicable contractor status, and sign before a notary. Email the completed form to [email protected].
- Do I need to sign this form in front of a notary?
- Yes. The form includes a sworn-to-and-subscribed jurat, so the contractor should sign before the notary, who completes the notary fields.
- Can I use remote online notarization for this form?
- North Carolina’s enacted remote electronic notarization program has not launched. Emergency video notarization requires the signer and notary to be in North Carolina and is not remote online notarization. Ask the City about an online notarization; confirm with the city or town if unsure.