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OhioBWC - Employer - Form: (U-117) - Introduction

Notification of Policy Update
(U-117)
Introduction

Use this form to notify BWC of changes to the legal business name and/or federal employer identification number or Social Security number for an existing policy. This form should only be used when an employer is essentially the same employer (same or similar ownership group). Also, use this form if you are transferring the business from one immediate family member to another.

This form is not intended for situations where the employer succeeds - in whole or in part - another employer in the operation of a business. If you are a new/successor employer and do not have a BWC policy, you will need to complete an Application for Ohio Workers' Compensation Coverage (U-3). If you already have a policy with BWC, you will need to complete a Notification of Business Acquisition/Merger or Purchase/Sale (U-118) to notify BWC.

Coverage is elective for sole proprietors, partners, individuals incorporated as a corporation (with no employees), ministers and officers of a family farm corporation. For more information about elective coverage, click here.

For individuals that qualify for this type of coverage, election for coverage may be made by completing an Application for Elective Coverage (U-3S).

Note: If you do not need to update your policy name and/or federal identification number but would like to make any of the policy updates listed below, please click here.
  • Update primary and/or mailing address and contact information
  • Request cancellation of elective coverage
  • Request cancellation of Ohio workers' compensation coverage
  • Request to update your doing business as name
  • Add and/or cancel corporate officer
  • View your authorized representative
  • View your current managed care organization

Required information
You will need the following information to complete the U-117.
  • New legal business name
  • New trade name or doing business as name
  • New federal employer identification number or Social Security number
  • Business entity type (charter number, incorporation date and state where incorporated for limited liability or corporations)
  • Reason for change in legal business name
  • Owner and officer's name, home address, Social Security number, phone number and percentage of ownership
  • Primary and mailing address

Complete the forms

The free Adobe Reader software is required to display and print the application.

Do you have all the required information at hand? If so, you are ready to begin completing the form. When completing the online form, please use the previous and next buttons located at the bottom of the page to navigate through the form.
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To print a blank copy of the form to complete by hand and either mail or fax it to BWC, click the link below.
Print a blank form.


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