W2 Request - OCMI Workers Comp

Company Name

Employee Name

Last 4 digits of SSN/ITIN

Year(s) of W-2 Requested

Full Mailing Address

How would you like your documents delivered?

To my email inbox

To my mailing address

E-mail Delivery Disclaimer

By submitting this request, I agree to accept my W-2 statement electronically at the e-mail address I have provided. I understand that by electronically signing below, I consent to receive Form W-2 in electronic format in lieu of receiving a paper copy. Employees may choose to receive their Form W-2 electronically in lieu of the paper version.When you receive your W-2 electronically, it will be attached to an e-mail as a PDF file. You will need PDF reading software (such as Adobe Acrobat Reader) and the hardware necessary to run the PDF reader software.

U.S. Postal Service Delivery Disclaimer

By submitting this request, I agree to accept a paper copy of my W-2 statement physically mailed to the address I have provided. Allow 5-15 business days to receive your W2 by US postal service.

When you receive your W-2 electronically, it will be attached to an e-mail as a PDF file. You will need PDF reading software (such as Adobe Acrobat Reader) and the hardware necessary to run the PDF reader software.

Signature: (Type)

By signing your name electronically on this form you are agreeing that your electronic signature is the legal equivalent of your manual signature on this form.