Independent Contractor Statement

WCB-267: Printable Independent Contractor Statement

Online filing is the preferred method for submitting the Independent Contractor Statement, however, the above printable version is available for those who do not have access to a computer or smart phone. Once completed, the form may be hand-delivered or mailed to:

Workers' Compensation Board
ATTN: Coverage Department
27 State House Station
Augusta, ME 04333-0027

Confirmation of receipt will not be sent. Please visit the Independent Contractors webpage to view a listing of statements received.

For questions regarding Independent Contractor Status, please email or call (207) 287-3751.