Get Si7 Form Ohio

Filling out the Si7 Form in Ohio is a straightforward process that allows employers to apply for the renewal of their self-insured policy. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the Si7 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the self-insured policy number in the designated field. This number is essential for identifying your application.
3. Fill in the renewal date. Ensure that this date is clearly indicated to avoid any confusion during processing.
4. Provide the company information, including the employer name as it appears on the Articles of Incorporation, federal ID number, and the address. Make sure to include the city, county, state, and nine-digit ZIP code.
5. Indicate the number of Ohio employees as of the application date, including any subsidiaries. This information is crucial for eligibility assessment.
6. Designate a corporate contact person along with their email address, phone number, and fax number for future communications.
7. Select the type of entity from the options provided: Corporation, Partnership, LLC, or Public Employer. Complete additional questions if ‘Public Employer’ is selected.
8. Enter the ultimate USA parent information, including the name, state of incorporation, federal ID number, date of incorporation, and percentage of ownership.
9. If applicable, provide information about any subsidiaries authorized to operate under the self-insured policy number, detailing their names, federal ID numbers, ownership percentages, and employee counts.
10. Fill in the corporate restructuring section, indicating whether there have been any changes in the corporate name or structure in the past year. Provide a detailed explanation if changes occurred.
11. Complete the Ohio administrator information, ensuring that the individual designated is an employee of the company.
12. Provide details regarding excess workers' compensation insurance if applicable, including policy details and any claims being paid.
13. Fill out the Ohio assets and gross payroll information as required.
14. Complete the certification section by entering the appropriate state and county, along with the corporate officer's signature and notary information.
15. Include details about claim file housing locations, ensuring that all necessary contact information and details about claims are provided.
16. Finally, review the entire form for accuracy. Once completed, you can save changes, download, print, or share the form as needed.

Complete your Si7 Form online today to ensure timely processing of your renewal application.