Forms
Of course forms are involved - it’s an insurance transaction after all. If your agent or a SAIF representative asks you to submit one during the application process (in addition to the standard ACORD form), you’ll find everything you need right here.
| Form Name | Ref. No. |
|---|---|
| ACORD™ workers' compensation application form Use this form to apply for SAIF coverage. Please contact us for assistance. |
ACORD |
| Cancellation of Election for Coverage as a Worker To cancel personal election coverage for an owner, this form is to be completed by an authorized representative of the business. |
X-3000 |
| Designation of Corporate Officer Exemption form - Construction, Timber Harvest or Landscape Industries To exempt a corporate officer from coverage, this form is to be completed by an authorized corporate representative. |
|
| Designation of Partner or LLC Member Exemption form - Construction or Landscape Industries To exempt a partner or LLC member from coverage, this form is to be completed by a partner or LLC member. |
|
| Nondisabling Claims Reimbursement form This form is available to each new and renewing policyholder on an annual basis as an offer to participate in the claims reimbursement program. If you choose to participate, return a signed form to SAIF. |
F-3135 |
| Personal Coverage Application for LLC Members To elect coverage for an LLC member, this form is to be completed by an LLC member. |
X-1462 |
| Personal Coverage Application for Nonsubject Corporate Officers To elect coverage for a nonsubject corporate office, this form is to be completed by an authorized corporate representative. |
X-1460 |
| Personal Coverage Application for Sole Proprietors or Nonsubject Partners To elect coverage for a sole proprietor or nonsubject partner, this form is to be completed by the owner or a partner in the business. |
X-1461 |
| Policyholder's Cancellation of Workers' Compensation Insurance To cancel your workers' compensation insurance policy, this form is to be completed by an authorized representative of the business. |
X-773 |
| Premium Credit Application This application is for Policyholders or Agents to complete. |
X-948 |