Application
Application Instructions
WORKERS’ COMPENSATION SELF-INSURANCEAPPLICATION INSTRUCTIONS
Application Document Checklist
CHECKLIST OF ITEMS TO BE INCLUDED WITH APPLICATION FOR WORKERS’ COMPENSATION SELF-INSURANCEApplication Fee Invoice
WORKERS’ COMPENSATION SELF-INSURANCE APPLICATION FINANCIAL REVIEW FEECompliance Guide for Self-Insurers
This guide is intended to provide your company with information on the filing requirements for individual self-insurers for workers’ compensation pursuant to Section 440.38, Florida Statutes.Form SI-1 - Application for Self-Insurance
APPLICATION FOR SELF-INSURANCEForm SI-4F - Surety Bond for FSIGA Member
SELF-INSURER'S SURETY BOND FOR FSIGA MEMBERForm SI-6 - Letter of Credit (PDF - Acrobat Format)
SELF-INSURER’S IRREVOCABLE LETTER OF CREDITForm SI-6 - Letter of Credit (DOC - Word Format)
SELF-INSURER’S IRREVOCABLE LETTER OF CREDIT. In DOC format (Microsoft Word compatible).Form SI-19 - Certification of Servicing
CERTIFICATION OF SERVICING FOR SELF-INSURERSGet Acrobat Reader
The files listed are in PDF format and require the Adobe Acrobat Reader to view them. If you do not currently have the Reader you can download it by visiting Adobe.
