For Clients: Applications
Safety Group Applications
Complete the following applications for the appropriate New York Workers' Compensation Safety Group
United Restaurants of New York, Inc. Safety Group #556
Retail Group of New York, Inc. Safety Group #544
Oil and Gas Dealers of New York Safety Group #582
There are seven forms for Fuel Oil Dealers of New York:
The Social and Health Services Group of New York Safety Group #585
There are six forms for Home Health Care Services of New York:
Wholesale Group of New York, Inc. Safety Group #551
Hotel and Motel Group of New York Safety Group #578
The Residential Care Facilities of New York Safety Group #586
There are six forms for Residential Care Facilities of New York:
- Residential Care Facilities Membership Application
- New York State Insurance Fund Workers' Compensation Application
- Group Authorization
- Fee Agreement
- Residential Care Facilities Proxy Card
- Request for Inclusion of Additional Interest
- Group Authorization for 586
Certificates
You may use the link below to log in to the website of The New York State Insurance Fund, 199 Church Street, New York, NY 10007, to obtain a Certificate of Insurance.
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