Ny political compensation 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name of your political subdivision or fire district in the designated field.
3. Fill in the address and federal tax identification number accurately to ensure proper processing.
4. Indicate whether a certified copy of the resolution for self-insurance is attached by checking the appropriate box. If not, provide an explanation in the space provided.
5. Enter the date when the election to secure compensation was made, followed by the effective date of this election.
6. If applicable, specify how employees were previously covered before this effective date, including any insurance policy details.
7. Decide if you will handle compensation matters directly or through a licensed representative and provide their details if necessary.
8. Complete the contact information for self-insurance matters, ensuring all fields are filled out correctly.
9. Finally, sign and date the form before submitting it as instructed at the bottom of the document.

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