Submit an eApplication for Your Client

Use Our Electronic Application

Brokers, agents and authorized representatives can submit NYSIF’s eApplication for new workers’ compensation policies on behalf of their clients in a few easy steps. Clients can digitally sign the application and pay the premium deposit online.

Start by using NYSIF eQuote to request a quote for NYSIF workers’ compensation insurance.

All applications must:

  • Be fully completed and signed by an officer/owner of the applicant’s business
  • Include a premium deposit

If not a new employer, you must include your client's loss runs for the last five years and one of the following items of payroll verification with the application:

  • A copy of your client’s previous insurance carrier 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 approved, coverage is effective at 12:01 a.m., Eastern Standard Time, the day after NYSIF receives the electronically signed application and electronic premium deposit. For approved mailed applications, coverage takes effect the day after the postmark on the envelope of the signed application and premium deposit, or any subsequent date requested.

Representatives and clients receive written notification containing a policy number and effective coverage date, followed by policy declaration and information pages.

If applying for coverage by mail, print and complete the appropriate application and supplemental questionnaire.

If your client needs disability benefits insurance, apply here.

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