Endorsement legal 2026

1. Click ‘Get Form’ to open the endorsement legal document in the editor.
2. Begin by entering the desired self-insurance effective date at the top of the form. This is crucial for establishing when your self-insurance will commence.
3. Fill in the certified self-insured employer's name and insurer number, along with your Federal Employer Identification Number (FEIN). This information identifies your business for regulatory purposes.
4. Provide the legal entity applicant's name and mailing address. Ensure accuracy to avoid any delays in processing.
5. List a company representative for self-insurance, including their name, title, company name, address, telephone, fax, and email. This person will be your point of contact.
6. Indicate your corporate status by selecting from options such as Individual, Corporation, Partnership, or LLC.
7. Complete sections regarding nature of business and employee details. Include primary NCCI classification codes and total payroll figures for accurate assessment.
8. Attach all required documents listed at the end of the form before submission to ensure a complete application.

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