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Subcontractor's Statement Regarding Workers Compensation Payroll Tax and Remuneration

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SUBCONTRACTOR’S STATEMENT REGARDING WORKERS COMPENSATION, PAY-ROLL TAX AND REMUNERATION

(Note 1)

s175B Workers Compensation Act 1987 Part 5B s31G-31J Pay-roll Tax Act 1971 ss127, 127A Industrial Relations Act 1996

(Note 2)

(Note 3)

(Note 4)

(Note 5)

DECLARATION

I, a Director of / a person authorised by the subcontractor on whose behalf this (delete as appropriate) declaration is made, hereby state that the abovementioned subcontractor:

Is either


OR

held with as indicated on the attached Certificate of Currency dated , in respect of work done in connection with the contract, during any period of the contract and has paid all workers compensation insurance premiums payable in connection with the contract (Note 7).

also a principal contractor in connection with the work under contract (Note 8).

been given a written statement by subcontractors in connection with the work.

required to be registered as an employer under the Pay-roll Tax Act 1971 (Pay-roll tax client No.)

(please print)

WARNING

• Any subcontractor, who knowingly provides a principal contractor with a written statement that is false, is guilty of an offence (Maximum penalty 100 units or $11,000).

• Any written statement will not relieve the principal contractor of liability if, at the time the written statement was provided, the principal contractor believed the written statement to be false.

• The principal contractor must retain a copy of any written statement for a period of not less than five years (Pay-roll tax), six years (Remuneration) or seven years (Workers compensation).

• This statement must be accompanied by the relevant Certificate of Currency to comply with section 175B of the Workers Compensation Act 1987

NOTES

1. This form is prepared for the purpose of section 175B of the Workers Compensation Act 1987, Part 5B section 31G-31J of the Pay-roll Tax Act 1971 and section 127 of the Industrial Relations Act 1996. If this form is completed in accordance with these provisions, a principal contractor is relieved of liability for workers compensation premiums, pay-roll tax and remuneration payable by the subcontractor.

2. For the purpose of this statement, a principal contractor is a person (or other legal entity), who has entered into a contract with another person (or other legal entity), referred to as the subcontractor, and employees/workers of that subcontractor will perform the work under contract. The work must be connected to the business undertaking of the principal.

3. In order to meet the requirements of s127 Industrial Relations Act 1996, a statement in relation to remuneration must state the period to which the statement relates.

Section 127(6) Industrial Relations Act 1996 defines remuneration as ‘remuneration or other amounts payable to relevant employees by legislation, or under an industrial instrument, in connection with work done by the employees.’

Section 127(11) of the Industrial Relations Act 1996 states ‘to avoid doubt, this section extends to a principal contractor who is the owner or occupier of a building for the carrying out of work in connection with the building so long as the building is owned or occupied by the principal contractor in connection with a business undertaking of the principal contractor.’

4. Payment claim details – Where a subcontractor has entered into a payment schedule with a principal contractor they must identify the period or payment to which the statement applies.

5. An accurate description of the work covered by the contract must be included.

6. In completing the statement, a subcontractor declares that they are a sole trader or partnership without workers or subcontractors and is not required to hold workers compensation insurance.

7. In completing the statement, a subcontractor declares that workers compensation premiums payable up to and including the date(s) on the statement have been paid, and all premiums owing during the term of the contract will be paid.

8. It is important to note that a business could be both a subcontractor and a principal contractor, if a business ‘in turn’ engages subcontractors to carry out work. If your business falls within this category you should also obtain statements from your subcontractors.

9. In completing the statement, a subcontractor declares that all pay-roll tax payable relating to work undertaken as part of the contract has been paid.

10. In completing the statement, a subcontractor declares that all remuneration payable has been paid.

It is noted that definitions of employer, employee, remuneration, and specific provisions for employers of outworkers in the clothing trades are as defined in s127A of the Industrial Relations Act 1996.

11. Failure to complete this statement may result in the principal contractor withholding any payment due to the subcontractor. Any penalty for late payment under the contract does not apply to any payment withheld under this subsection. Subcontractors may wish to keep a copy of the statement for their own records.

For more information, please visit the WorkCover website www.workcover.nsw.gov.au, Office of State Revenue website www.osr.nsw.gov.au, or Office of Industrial Relations, Department of Commerce website www.commerce.nsw.gov.au. Copies of the Workers Compensation Act 1987, the Pay-roll Tax Act 1971 and the Industrial Relations Act 1996 can be found at www.legislation.nsw.gov.au.

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What this Subcontractor's Statement Is and when it's used

The Subcontractor's Statement Regarding Workers Compensation Payroll Tax and Remuneration is a written attestation that a subcontractor provides to a contractor or hiring entity to confirm payroll tax treatment, workers' compensation coverage status, and how remuneration is reported. It typically clarifies whether the subcontractor is treated as an independent contractor or employee for payroll tax and workers' compensation purposes, identifies the payroll basis used to calculate premiums, and records any applicable exemptions or policy numbers. Contractors collect the statement to meet audit, insurance, and tax-recordkeeping obligations and to reduce misclassification and premium-allocation risk under federal and state rules.

Why this statement matters for compliance and risk control

This statement helps contractors demonstrate due diligence for payroll tax reporting and workers' compensation premium allocation, and it reduces exposure to misclassification claims and audit adjustments under federal and state law.

Why this statement matters for compliance and risk control

Who completes or requests this subcontractor attestation

Contractors, payroll managers, and risk or compliance teams commonly request this statement before onboarding or paying a subcontractor.

  • General contractors verifying subcontractor coverage and payroll basis before issuing final payments.
  • Payroll or accounting teams reconciling worker classification and tax-reporting obligations for 1099 workflows.
  • Risk managers and insurers confirming workers' compensation premium allocation and policy coverage.

Use the statement as part of vendor onboarding and contract files to support audits and to reduce downstream liability.

Step-by-step: complete and deliver the subcontractor statement

Follow these steps to reduce errors and ensure the document is accepted by payroll and insurance teams.

  • 01
    Prepare document: Use a standard form with labeled fields and signature block.
  • 02
    Collect details: Request TIN, WC policy number, and payroll classification.
  • 03
    Sign and date: Ensure authorized signer signs and dates the form.
  • 04
    Submit to payer: Send completed form to the contractor's payroll or compliance contact.

Typical routing and processing flow for the statement

A predictable workflow prevents delays in payment and limits exposure to audits and premium reallocations.

  • Upload: Sender uploads form to document management or e-sign platform.
  • Assign fields: Place signature, date, and required data fields on the form.
  • Sign: Subcontractor signs electronically or in writing as authorized.
  • Store: Store executed copy with payroll and insurance files.

Recommended digital workflow settings for e-submission

Configure your eSignature and document management system to validate fields and preserve audit trails.

Field Configuration
Require TIN Make TIN a required field with input mask
Date format Enforce MM/DD/YYYY date entry
Signer authentication Use email + SMS code for moderate assurance
Audit trail Capture IP, timestamps, and action log

Digital signing essentials and platform compatibility

Ensure the platform supports secure eSignature capture, audit trails, and common file formats.

  • File formats: PDF and DOCX supported
  • Authentication: Email, SMS, or stronger methods
  • Integrations: Connects with payroll and storage systems

Align platform settings with legal and recordkeeping policies before e-submitting statements.

Important timing and related tax deadlines to know

Use these tax and reporting dates to coordinate statement collection with year-end reporting and payroll cycles.

Provide on demand:

W-9-style info provided upon payer request; no fixed deadline

1099-NEC deadline:

File and furnish by Jan 31 for nonemployee compensation

1099-MISC timing:

Recipient due Jan 31; IRS paper Feb 28, electronic Mar 31

Form 1040:

Individual return due April 15; extension to Oct 15 with Form 4868

I-9 retention:

Retain per hire/termination rules in 8 CFR §274a.2

Key processing milestones from collection to retention

A clear milestone plan helps coordinate payroll, insurance, and tax reporting tasks.

01

Request form

Ask subcontractor for the completed statement during onboarding.

02

Verify entries

Confirm TIN, policy numbers, and dates before payment.

03

Recordkeeping

Attach executed form to payroll and insurance files.

04

Retention review

Review retained files per statutory retention requirements.

Common mistakes that delay acceptance or cause penalties

  • Missing or mismatched TINs leading to backup withholding or delayed payments.
  • Expired or missing workers' compensation policy details triggering insurer disputes and premium reassessments.
  • Unsigned or undated statements that render the attestation invalid for audit purposes.
  • Overly vague payroll basis descriptions that prevent accurate premium allocation or tax reporting.

Penalties and legal risks from incorrect or absent statements

Backup Withholding: 24% withholding on payments
1099 Penalties: $60–$330 per form depending on delay
Intentional Disregard: $660+ per form no cap
I-9 Violations: $281–$2,789 per violation
WC Audit Reallocation: Higher premiums and retroactive charges
Insurance Denial: Coverage disputes for misclassified workers

Security and compliance considerations for stored statements

Encryption in Transit: TLS 1.2/1.3
Encryption at Rest: AES-256
Audit Standards: SOC 2 Type II available
Healthcare Compliance: HIPAA BAA required
Regulatory Support: 21 CFR Part 11 compliance
Signature Law: ESIGN and UETA recognized

Core elements included in a professional subcontractor statement

A complete statement balances concise attestation with fields that support payroll, insurance, and tax workflows.

Identification

Legal name, business structure, and taxpayer identification to match payroll and IRS records and avoid withholding.

Workers' Compensation

Policy number, insurer name, and coverage dates to confirm active coverage and premium allocation.

Payroll Classification

Declared contractor/employee status with a short rationale tied to contract terms and control factors.

Payroll Basis

Method used to compute reportable payroll for insurance and premium purposes, including exclusions or special categories.

Representations

Attestations about truthfulness, authority to sign, and acceptance of indemnity or audit cooperation clauses.

Execution

Authorized signature, printed name, title, and MM/DD/YYYY date to establish effective date and signer accountability.

How this statement differs from related tax and employment forms

Comparison to common forms clarifies purpose, required data, and whether notarization or in-person review is involved.

Criteria Subcontractor's Statement W-9 1099-NEC I-9
Primary purpose attest wc/tax status request tin report nonemployee pay verify work authorization
Required for payments often required pre-payment provided on request furnished for reporting required at hire
Notarization needed no (in-person document review required)
eSignature accepted yes if esign/ueta met no (i-9 requires physical document review)

eSignature vendor comparison for executing and storing statements

Pricing and core features for common eSignature platforms. signNow is presented first as the reference column.

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

Representative signers and decision-makers for the statement

Owner / Sole Proprietor

A small-business owner or sole proprietor signs to attest to classification and coverage; their signature binds the business and supports contractor due diligence during onboarding and audits.

Authorized Representative

A company officer, payroll manager, or HR representative with authority signs on behalf of the subcontractor; include title and authority statement to confirm signatory power for compliance.

Frequently asked questions about the subcontractor statement

Answers to common questions about completion, e-signatures, and practical implications for payroll and insurance.


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