ACORD 134 NJ (2007/01)

Section Name
Field Name
Field and/or Section Description
ACORD 134 NJ (2007/01)
New Jersey Workers Comp.
Insurance Plan Notice of Election -
Proprietors and Partners
This form must be completed and submitted with an application to the Compensation
Rating and Inspection Bureau of New Jersey, in each case where any entity is operated as
a proprietorship or any type of partnership, including a limited liability partnership or limited
liability company.
ACORD 134 NJ (2007/01)
1 of 1