Parent Company Agreement Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Parent Company Agreement Form. This is a New Hampshire form and can be use in Self-Insurance Workers Comp.
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Tags: Parent Company Agreement, New Hampshire Workers Comp, Self-Insurance
State of New Hampshire
Department of Labor
George N. Copadis
Labor Commissioner
David M. Wihby
Deputy Labor
Commissioner
State Office Park South
95 Pleasant Street
Concord, NH 03301
603/271-3176
TDD Access: Relay NH
1-800-735-2964
FAX: 603/271-6149
http://www.labor.state.nh.us
PARENT COMPANY AGREEMENT
THIS IS TO CERTIFY that
Name of Corporation
Home Address
agrees to and does guarantee the direct payment of employee-leasing company benefits in
accordance with the employee-leasing law of New Hampshire, RSA 277-B, as amended and
all rules and regulations promulgated thereunder, of
(Name of Corporation), of
(Home Address), being a subsidiary of the aforesaid parent company, an employer and an
employee-leasing company in the said state.
It is further agreed that the liability of the parent corporation shall be that of the
employee-leasing company and that upon default of the employee-leasing company the labor
commissioner of the said state may demand of the said guarantor payment of the said benefits
in manner prescribed by him.
This agreement shall not be terminated without a sixty-day prior written notice to the
said commissioner. Written notice of such termination shall not relieve the parent corporation
of its liability under this agreement for obligations that occurred prior to the effective date of
such termination.
IN WITNESS WHEREOF I set my hand and seal this
day of
A.D. 20
.
______________________________________________
Official's Name
______________________________________________
Title
(ELPI) Parent Company Agreement
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