Workers' Compensation Insurance Solutions

Applications

Workers' compensation applications

Below are specific insurance applications and important documents required in order to place coverage with NYSIF and the Safety Group programs.

View and Download Workers' Compensation Applications

Name Link
NYS Safety Group 491 Group Acceptance Form View Document
NYS Safety Group 497 Group Acceptance Form View Document
NYS Safety Group 491 Workers' Comp Quote Sheet View Document
NYS Safety Group 497 Workers' Comp Quote Sheet View Document
NYSIF VAWBL Application View Document
NYSIF VFBL Application View Document
U-431 Form View Document
U-435 Form View Document
ERM-6 Form View Document