Submitting an Application for NYSIF Workers' Compensation Insurance

Start the application process by obtaining a workers’ compensation quote using NYSIF eQuote, our electronic quote system that keeps track of your submitted quote and allows you to complete the application online. Once completed, you can download, print and submit the application. All applications must:

  • Be fully completed and signed by an officer/owner;
  • Include a check for the deposit premium.

If your client is not a new employer, at least one of the following items of payroll verification MUST accompany the application:

  • A copy of your previous insurance carrier’s premium audit bill showing classifications and payrolls for the most recent policy period;
  • Copies of Federal Tax Form 941 for the last four quarters;
  • Copies of New York State Tax Form NYS-45-MN quarterly combined withholding, wage reporting and unemployment insurance return for the last four quarters.

If your client has been previously insured you MUST include loss runs for the last five years. Include any additional requested information or forms.

You will be notified when NYSIF receives the application if there is incomplete information or premium owed on a prior policy. If approved, coverage becomes effective at 12:01 a.m., Eastern Standard Time, the day following the postmark of your mailed application and premium deposit check or, the day after NYSIF receives the application and check, or any subsequent date requested. You and your client will receive written notification of the policy number once assigned and the effective date of coverage. Policy declaration and information pages will follow shortly thereafter.

If you are unable to use our NYSIF eQuote system, you can print the following applications and supplemental questionnaires: