Underwriting Form ERM 14

You can now enter your information directly into the ERM 14 Form (PDF) on screen and then PRINT to Paper or PDF.

Please print out a copy for your records

PLEASE NOTE: The only way to SAVE the form WITH your contents is to PRINT to Microsoft XPS Document Image Writer
- OR - to a PDF wirter (such as CutePDF, Adobe Acrobat, Nitro, FoxIt, etc.).

Follow Instructions Below - It's as Easy as 1 - 2 - 3

Here are some Helpful Hints when completing the ERM 14 in the PDF Format

Use Mouse or Tab key to navigate through the form (Please note the Enter key will bring you to the end of the form)

Use Mouse in boxes to “check all that apply”.

Place additional narrative on the employer’s letterhead

Print the form (and narrative) and obtain proper signature

GO TO FORM: ERM-14 Form

SEE: Additional ERM-14 Form Instructions

To print the form to PDF, simply SELECT a PDF or electronic document printer as your printer.

See screen shot

See list of EXAMPLES of PDF writers below:

Microsoft XPS Document Image Writer: (Installed by default on newer PCs)
Adobe Acrobat
CutePDF (download CutePDF free)
Foxit PDF Printer

Or you may use any other PDF Printer/ electronic document writer

PLEASE NOTE: The only way to SAVE the form WITH your contents is to PRINT to a PDF.

Submit completed ERM-14 Form below:

Pennsylvania Workers Compensation Specialists