New Jersey Workers Compensation Insurance Notice Mandatory

Form 16 NJ A	
POSTING NOTICE
The law requires every insured employer to post and maintain
notices naming the company insuring its compensation liability “in
a conspicuous place or places in and about the employer’s place of
business.” The form of notice is prescribed by the Commissioner of
Insurance and shall be clearly printed on a minimum of 90# index,
8½" by 11" in size. The content and arrangement of items must be
consistent with the layout shown below. In accordance with 3:2-1 a
duplicate filing must be made before the form is placed in use. 
NOTICE
The undersigned employer hereby gives notice that the pay-
ment of compensation to employees and their dependents has
been secured in accordance with the provisions of the Employ-
er’s Liability Insurance Law, Title 34, Chapter 15, Article 5,
Revised Statutes New Jersey, by insuring with the 
(  ) Insurance Company 
for the period
Beginning ................ Ending ...................
Employer ...........................................
In accordance with the above cited law, notice of compliance
must be posted and maintained conspicuously in and about
the employer’s workplaces.	
Form 16 NJ A

Form 17 NJ 	
 	
AVISO 	
 
El patron avisa que ha asegurado el pago de compensación a los empleados y sus 
dependientes, de acuerdo con lo provisto por la ley de responsabilidad de los 
patrones de seguro para sus empleados.  Titulo 34, Capitulo 15, Articulo 5, revision 
de estatutos del Estado de New Jersey, asegurandolos con.  
 
(   ) Compañia de Seguro  
 
por el periodo 
 
Comenzando .................................. Terminando ................................................  
Patron ..................................................................................................................  
 
De acuerdo con la ley mencionada arriba, esta noticia debe ser colocada y 
mantenida en un lugar visible en todos los lugares de trabajo. 
 
Form 17NJ