Forms and Related Instructions

• General Information Brochure

• Initial Report Form (Instructions)  

• Moonlighting Surcharge Rating System Agreement  

• Non-resident Certification 

• Non-admitted Insurer Declaration of Compliance (Instructions)

• Notice of Cancellation/Termination sample and Instructions

• Notice of Basic Coverage (Instructions)

• Refund Request and Instructions

• Request to Decrease Fund Coverage

• Request to Increase Fund Coverage

• Request for Exemption from payment of tail coverage 
  - Affidavit of Disability
  - Affidavit of Temporary Absence
  - Affidavit of Extension of Temporary Exemption
  - Affidavit of Retirement
  - Affidavit of Temporary Absence due to Military Duty 

• Self-Insurance Certificate Application and Instructions