Workers' Compensation Payroll Audit from Church Mutual

By clicking “Accept”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. View our Privacy Policy for more information.

Deny Accept

Start Your Workers’ Compensation Payroll Audit

Fill out the form below to submit your payroll audit today! If you have questions as you’re completing the audit, please contact us by calling (800) 554-2642 or emailing premiumaudit@churchmutual.com.

View instructions & example

General Information

Today's Date: mm/dd/yyyy

If your account number appears as 6 digits, please preface with 0.

Policy period start:Policy period end:

Employee Information

Have questions? View a Sample Audit. All fields required.

#	Name of employee 1099 contractor or uninsured contractor	Job title	Gross payroll for audit period	Rent-free living quarters or housing allowance (text or dollar amount)	Meals - Camps (text or dollar amount)
1

*YES, I hereby certify that the information provided is a true statement of gross earnings paid to all employees for the audit period.

Any new locations added during the audited term?
If so, please enter in the Comments box below, the new full physical location addresses, the number of employees for each new location, and the intended building use (i.e. daycare, church, camp)

Certificates of Insurance (optional):
Attach certificates of insurance for any contractors used during the audit period. (.jpg, .xls, .xlsx, .doc, .docx, .pdf only. Approximately 5mb and under file size recommended.) Do not include 941 statements, employee payroll records, housing verifications, check registers etc.

Certificate Upload 1:

Choose File

No file chosen

+ Add Another Certificate

download printable version

submit audit for processing

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Why are premium audits necessary?

Each year, your workers’ compensation premium is developed with an estimated payroll. The audit process is necessary to determine your final premium by using the actual, not estimated, premium basis.

What is included in payroll?

Payroll refers to the yearly gross wages you pay your employees prior to any deductions, such as social security or withholding taxes. Payroll, for workers’ compensation purposes, may not be the same as payroll reported for tax purposes.

Start Your Workers’ Compensation Payroll Audit

General Information

Employee Information

Payroll audit FAQs

We’re here for you