S.D. Codified Laws § 62-1-20

The affidavit must be on a form prescribed by the director of the Division of Insurance and must be notarized. The director of the Division of Insurance may promulgate rules pursuant to chapter 1-26 to provide definitions, the form and process for filing the affidavit, and documentation required for filing an affidavit of exemption from the South Dakota Workers' Compensation Law.

The affidavit of exempt status shall contain substantially the following:

(1) Statements that the affiant:

(a) Is not an employee and does not want a workers' compensation insurance policy;

(b) Has read, signed, and understands the exempt status fact sheet attachment to the affidavit;

(c) Understands that the affiant will be considered an independent contractor and will not be considered an employee under the South Dakota Workers' Compensation Law;

(d) Understands that the affiant will not be eligible for compensation under the South Dakota Workers' Compensation Law;

(e) Understands that the signing of the affidavit creates a rebuttable presumption that the affiant is not an employee for the purpose of the South Dakota Workers' Compensation Act;

(f) Understands that the signing of the affidavit does not affect the rights or coverage of any employee of the affiant;

(g) Is not signing the affidavit or providing information as a result of force, threat, coercion, compulsion, or duress; and

(h) Understands that knowingly providing false information on an affidavit of exempt status under the South Dakota Workers' Compensation Law is a Class 2 misdemeanor; and

(2) An exempt status fact sheet, to be attached to the affidavit, which:

(a) Delineates the legal requirements recognized in law for determining whether a person is an independent contractor; and

(b) Contains a statement that the affiant believes they are an independent contractor given the preceding list of legal requirements.

Source: SL 2015, ch 262, § 2.