Self Insurance Templates

This Form is used for businesses in Texas to notify the authorities of their election to self-insure for workers' compensation coverage.

This Form is used for applying for qualification as a self-insurer for general liability in the state of Texas.

This form is used for giving notice of election to self-insure for LPG (liquefied petroleum gas) in the state of Texas.

This document is used for certifying a political subdivision's self-insurance for workers' compensation, general liability, and/or motor vehicle liability insurance in Texas.

This document provides instructions on how to file property claims for fire and tornado damage in Kentucky if you are self-insured.

This Form is used for requesting a Liability Statement of Self-insurance (SOSI) in the state of Hawaii.

This form is used for self-insured employers in Michigan to request the addition or deletion of a subsidiary or affiliate to their coverage.

This form is used for self-insured groups in Michigan to notify the termination of membership.

This Form is used for transferring claims between self-insurers in the state of Michigan.

This document is for religious groups in Missouri to apply for self-insurance and provide an affidavit.

This form is used for applying for a Certificate of Self-insurance for autonomous vehicle deployment in California.

This form is used for applying for self-insurance for a motor vehicle in the state of Kentucky. Self-insurance allows individuals to provide proof of financial responsibility for the vehicle instead of purchasing traditional auto insurance coverage.

This form is used for filing the quarterly statement for a liability self-insurance group in the state of Kentucky.

This form is used for applying for a self-insurance certificate in the state of Louisiana. Self-insurance allows individuals or organizations to provide their own insurance coverage instead of purchasing it from an insurance company.

This document allows Nebraska residents to apply for self-insurance, which is when individuals or organizations choose to bear the financial risk of potential losses instead of purchasing traditional insurance policies.

This form is used for self-insured employers in Washington state to issue a closure order and notice for permanent partial disability cases. It must be completed and submitted to the appropriate authorities.

This form is used for self-insured employers in Washington to officially close a time-loss claim and notify the employee.

This type of document is a Self-insurance Certification Questionnaire specific to the state of Washington. It is used to certify self-insurance for certain types of insurance required by businesses in Washington.

This form is used for applying to become a self-insurance sponsor or instructor in Washington and obtain course approval for continuing education in the insurance industry.

This form is used for applying and getting approved for continuing education credits for self-insurance in Washington.

This form is used for self-insured employers in Mississippi to apply for coverage with the Mississippi Workers' Compensation Commission (MWCC).

This Form is used for the financial test of self-insurance in the state of West Virginia.

This form is used for conducting a financial test of self-insurance in the state of West Virginia. It provides instructions on how to assess the financial stability and solvency of self-insured entities.

This document is used for self-insurance purposes in Wisconsin to demonstrate financial responsibility. It ensures that individuals or organizations can cover any potential liabilities arising from accidents or damages.

This Form is used for reporting vocational services provided under a self-insurance plan in the state of Washington.

This document is for those who want to become a workers' compensation self-insurance fund in the state of Louisiana. It is an application form that needs to be filled out and submitted to the relevant authorities.