Submitting an Application

Submitting an application has never been easier using NYISF on-line services. Start the application process by obtaining a workers’ compensation quote, using eQuote. Our electronic quote system keeps track of your submitted quote, and allows you to complete the application online. Once you have completed the application, it may be easily downloaded, printed and submitted.

All applications must: 

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

If you are 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.

Employers that have been previously insured MUST include loss runs for the last five years.  Include any additional requested information or forms.

Once NYSIF receives the application, an underwriter will review it for completeness. If there is any incomplete information, or premium owed on a prior policy, you will be notified.  If approved, coverage will become effective as of 12:01 a.m., Eastern Standard Time, the day following postmark on the envelope in which you mailed the application and deposit premium check, or any subsequent date requested. If the application and check are delivered by other means, coverage will become effective as of 12:01 a.m., Eastern Standard Time, the day after NYSIF receives the application and check, or any subsequent date requested.

You will receive written notification of the policy number once assigned and the effective date of coverage. The policy declaration and information pages will follow shortly thereafter.

If you are unable to use our eQuote system, the below applications and supplemental questionnaires can downloaded and printed:

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