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Petition for Executive Officer Waiver

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PETITION FOR EXECUTIVE OFFICER WAIVER

An executive officer of a business corporation (AS 10.06), a cooperative corporation (AS 10.15), an electric and telephone cooperative corporation (AS 10.25), or a professional corporation (AS 10.45) may waive their rights to benefits under the Alaska Workers’ Compensation Act (AS 23.30). To receive an Executive Officer Waiver, the following completed form and attachments must be submitted to the Division of Workers’ Compensation at the above address.

1. Legal Name of Corporation

2. Federal Employer Identification No.

3. Entity Physical Address

4. Corporate Executive Officer(s) (Attach a separate sheet of paper if more space is needed)

Name

Name

Title(s)

Title(s)

Mailing Address

Mailing Address

Name

Name

Title(s)

Title(s)

Mailing Address

Mailing Address

5. Requestor's Name

6. Requestor's Phone #

7. Requestor's Email

An executive officer means an employee of the corporation the president, vice-president, secretary, treasurer, or a corporate employee who is responsible for the corporation’s affairs generally, has a close connection to the board of directors and other officers, and who is specifically designated as an executive officer in the corporation’s articles and bylaws.

To obtain an Executive Officer Waiver, a corporation must satisfy the following requirements

a. Each officer must read and sign the Affidavit of Corporate Officers form. Each officer’s signature must be signed before a Notary Public. Be advised that the Alaska Corporate Code (AS 10.06) requires each corporation to have at least a President and Secretary. The office of the President and Secretary cannot be held by one individual, unless that person is the sole shareholder

b. The corporation’s status must be active and in good standing with the Alaska Division of Corporations, Business, and Professional Licensing. If you are unsure of your corporate status, contact the licensing section at (907) 465-2534.

c. The names of the executive officers contained in the petition must correlate with the listed officials found on the Alaska Division of Corporations, Business, and Professional Licensing website.

d. The following must be included in this application.

  • A copy of the first page of articles of incorporation and page(s) of the bylaws that state officer titles and duties
  • A copy of the minutes of the corporate meeting that reflects the election or appointment of the designated individuals as corporate executive officers

Amending an existing Executive Officer Waiver:

e. To add or change executive officers, a new petition must be submitted with an affidavit signed and notarized by each individual listed in the petition. A copy of page(s) of minutes of corporate meeting that reflects the changes in corporate officers must be included.

f. To remove an executive officer from a waiver, or cancel a waiver, the corporation must submit a written request to have the officer removed or the waiver cancelled. The request must be signed by the person who was covered under the waiver, or by the president of the corporation.

Please note: All documentation submitted is considered public information.

Incomplete applications will be returned.

AFFIDAVIT OF CORPORATE OFFICERS

Legal Name of Corporation

I, , being first duly sworn, state I am a duly elected or appointed officer of the above named corporation. I request a waiver from coverage under the Alaska Workers’ Compensation Act. I am voluntarily, without coercion, signing this waiver request. I understand that I will not qualify for benefits in the event of a work related injury sustained during the performance of my duties as a corporate executive officer.

Signature Of Officer

Notary Public in and for the State of

Signature of Notary Public

Subscribed to me this

day of

My Commission Expires

I, , being first duly sworn, state I am a duly elected or appointed officer of the above named corporation. I request a waiver from coverage under the Alaska Workers’ Compensation Act. I am voluntarily, without coercion, signing this waiver request. I understand that I will not qualify for benefits in the event of a work related injury sustained during the performance of my duties as a corporate executive officer.

Signature Of Officer

Notary Public in and for the State of

Signature of Notary Public

Subscribed to me this

day of

My Commission Expires

I, , being first duly sworn, state I am a duly elected or appointed officer of the above named corporation. I request a waiver from coverage under the Alaska Workers’ Compensation Act. I am voluntarily, without coercion, signing this waiver request. I understand that I will not qualify for benefits in the event of a work related injury sustained during the performance of my duties as a corporate executive officer.

Signature Of Officer

Notary Public in and for the State of

Signature of Notary Public

Subscribed to me this

day of

My Commission Expires

I, , being first duly sworn, state I am a duly elected or appointed officer of the above named corporation. I request a waiver from coverage under the Alaska Workers’ Compensation Act. I am voluntarily, without coercion, signing this waiver request. I understand that I will not qualify for benefits in the event of a work related injury sustained during the performance of my duties as a corporate executive officer.

Signature Of Officer

Notary Public in and for the State of

Signature of Notary Public

Subscribed to me this

day of

My Commission Expires

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What the Petition for Executive Officer Waiver Is

A Petition for Executive Officer Waiver is a formal request submitted to an agency, licensing board, or corporate authority asking for relief from a regulatory, statutory, or contractual requirement that otherwise applies to an executive officer. The petition typically explains the facts, identifies the specific rule or qualification for which relief is sought, and documents why enforcement would be impracticable, inequitable, or contrary to public interest. Many agencies treat these petitions as discretionary and evaluate them on the demonstrated hardship, supporting evidence, and statutory standards that govern waivers.

Why a Well-Prepared Petition Matters

A clear, complete petition increases the likelihood that reviewers can decide on the merits without repeated requests for information. Proper documentation frames the legal basis for relief, shows compliance intent, and shortens review cycles while preserving record integrity under ESIGN and state e-record laws such as UETA.

Why a Well-Prepared Petition Matters

Who Typically Prepares or Signs This Petition

Organizations and counsel prepare petitions when an executive officer cannot meet a regulatory qualification due to timing, disability, or exceptional circumstances.

  • Public companies and boards seeking temporary relief for a named officer when statutory qualifications lapse.
  • Private companies and LLCs asking for administrative waivers tied to licensing or securities filings.
  • Outside counsel or in-house legal teams drafting factual narratives and legal arguments for the petition.

Typical Signers and Preparers

Corporate Secretary

Often prepares and certifies factual corporate records attached to the petition, attests to board actions, and provides formal proof of corporate authority required by many agencies.

General Counsel

Drafts the legal argument for waiver, aligns citations to statute or regulation, and signs where an attorney certification or signature block is required by the receiving authority.

Core Components to Include in a Professional Petition

Assemble a concise package that gives reviewers an immediate factual and legal basis for relief. Each section should be labeled, supported by exhibits, and formatted for easy review.

Cover Letter

One-page summary addressing the agency, the statute or rule at issue, the precise relief requested, and a short statement of reasons supporting the waiver request.

Statement of Facts

Chronological, objective summary of events and circumstances that led to the waiver request; include dates, material actions, and relevant documentation references.

Legal Argument

Concise citation of statutory or regulatory provisions, legal standards for waiver, and an explanation applying facts to the legal test for relief.

Supporting Evidence

Exhibits such as medical records, board resolutions, financial statements, affidavits, or third-party letters that corroborate factual assertions and show substantiation.

Authority and Signatures

Designation of the petitioner, proof of authority (e.g., board resolution), and signature blocks for required signatories with dates and contact information.

Proposed Conditions

If applicable, suggested conditions or time limits the agency can impose in granting a conditional waiver to protect public interest.

Step-by-Step: Preparing and Submitting the Petition

Follow a clear sequence: prepare drafts, gather exhibits, confirm signatory authority, choose submission method, and retain proof of delivery.

  • 01
    Draft the Petition: Write factual summary and legal argument aligned with agency standards.
  • 02
    Assemble Exhibits: Attach supporting documents with a numbered exhibit index.
  • 03
    Obtain Authorizations: Secure board resolutions or written authority for filing.
  • 04
    Submit and Record: File via agency portal or certified delivery and keep proof of submission.

Configuring an Online Petition Workflow

Set up your electronic workflow to collect signatures, verification, and attachments in a single, auditable process.

Field Configuration
Signer Order Sequential signing with corporate secretary before counsel
Authentication Email plus SMS code or ID verification where required
Conditional Fields Show additional fields when certain options are selected
Attachments Required Enforce uploaded exhibits before final submission

Where to File or Send the Petition

Confirm the receiving authority and their accepted delivery methods before filing to ensure proper routing and receipt.

  • Agency Portal: Use the agency's electronic submission system when available.
  • Email Submission: Allowed only if the agency's rules permit electronic filing.
  • Certified Mail: Use for paper filings requiring proof of delivery.
  • In-Person Delivery: Follow clerk hours and receipt-stamping policies for court or board filings.

Digital Signing and eSubmission Considerations

Use an e-signature platform that supports audit trails, document export, and required signer authentication.

  • File Formats: PDF/A or PDF recommended for stable records
  • Authentication Options: Email, SMS code, KBA, or ID analysis
  • Integrations: Connectors such as Salesforce, NetSuite, and Google Workspace

Timing and Processing Expectations

There is no universal deadline for an executive officer waiver; timing depends on agency rules and whether the petition is tied to a filing or compliance deadline.

Immediate Filings:

When tied to a regulatory deadline, file as early as possible to avoid penalties.

Agency Review Time:

Varies widely; some agencies acknowledge within 14–30 days.

Requests for Additional Information:

Respond promptly; delays can lead to dismissal.

Conditional Grants:

Grants may include reporting or time-limited conditions.

Appeals Window:

Check agency rules for specific appeal or reconsideration timelines.

Key Milestones in the Petition Process

Track milestones from preparation through final decision to manage obligations and document preservation.

01

Prepare Petition

Draft narrative, exhibits, and proof of authority.

02

File With Agency

Submit via accepted channel and retain proof.

03

Respond to Inquiries

Provide additional documents within requested timeframe.

04

Decision Issued

Agency grants, denies, or grants conditionally.

Common Mistakes to Avoid When Preparing the Petition

  • Submitting incomplete exhibits or failing to number attachments makes it harder for reviewers to verify claims and can cause delays.
  • Using informal or ambiguous language for the relief sought, rather than citing the exact provision to be waived, weakens legal argumentation.
  • Failing to show proof of signatory authority, such as a board resolution, often leads to requests for verification or outright rejection.
  • Relying on an unsupported timeline or failing to explain interim remedial steps can make a petition appear speculative rather than remedial.

Consequences of an Incorrect or Deficient Petition

Denial of Relief: Petition may be denied without prejudice
Processing Delays: Incomplete submissions trigger requests for information
Financial Penalties: Agency fines or late fees may apply
Regulatory Exposure: Continued noncompliance may lead to enforcement action
Reputational Risk: Public disclosure of enforcement matters
Invalid Signatures: Improper execution can void the petition

Essential Information to Include on the Form

Petitioner: Legal entity name
Officer: Full legal name
Authority: Title or role
Contact: Email and phone
Effective Date: MM/DD/YYYY format
Exhibits: Numbered list

Real-World Examples of Executive Officer Waivers

These anonymized summaries and customer stories show how petitions are framed and validated in practice.

Optica Ventures LLC — Brian Fitzgibbons

Optica needed expedited documentation for a newly appointed officer

  • The team submitted a concise facts summary with board resolution
  • The process highlighted the value of clear exhibits and authoritative corporate certification for timely agency review.

Martin Properties — Tim Martin

A small RE firm sought temporary relief for an officer unable to sign due to medical reasons

  • They submitted medical documentation and a conditional powers arrangement
  • The agency granted a time-limited waiver with reporting conditions to protect third-party interests.

Practical Tips for Accurate and Efficient Petitions

Adopt consistent practices to reduce review cycles and evidentiary gaps when filing petitions.

Verify Signatory Authority in Advance
Confirm and document board approvals, corporate resolutions, or delegated authority in writing before filing so the agency can accept the petition without follow-up.
Number and Cross-Reference Exhibits
Use an exhibit index and cite exhibit numbers in the narrative; cross-referencing reduces ambiguity and accelerates reviewer verification.
Use Clear Legal Citations
Cite the precise statutory or regulatory provision you seek to waive and explain how the facts meet the agency's waiver standard or discretionary criteria.
Retain Submission Proof
Keep electronic receipts, signed PDFs with audit trails, and certified mail records to show timely filing and to support any appeals or reconsideration.

eSignature Pricing Snapshot for Submitting Petitions

Compare core pricing and capability points relevant to executing and storing petition documents electronically; signNow is listed first for reference.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions About Petitions and eSubmission

Answers to common procedural and technical questions to reduce filing errors and clarify electronic submission requirements.


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