Submit an Application for NYSIF Workers' Compensation Insurance

To obtain a NYSIF workers' compensation insurance policy, start the application process by requesting a NYSIF workers’ compensation insurance quote using NYSIF eQuote. Our electronic quote system 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 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.

Previously-insured employers MUST also include loss runs for the last five years.

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 will receive written notification of your policy number and the effective date of coverage. Policy declaration and information pages will follow.

If you are unable to use NYSIF eQuote, you can print the following NYSIF workers' compensation insurance applications and supplemental questionnaires:

 
Title
Workers' Compensation Application
Building Demolition
Roofing Contractors
Volunteer Firefighters Application
Volunteer Ambulance Workers Application

Adobe Reader is required to view one or more of these documents. You may download Adobe Reader by clicking on the button below.

Get Adobe Reader