Get Supplemental Application Form - State Compensation Insurance Fund

Completing the Supplemental Application Form for the State Compensation Insurance Fund can seem daunting, but with the right guidance, you can navigate it smoothly. This guide will provide you with clear, step-by-step instructions to help you fill out each section of the form online.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the Supplemental Application Form and open it in your editor.
2. In Section 1, enter your current trade name, if applicable, along with any prior trade name you may have used.
3. In Section 2, provide the legal name of the business and select the legal entity type that applies to your situation by checking the appropriate box.
4. Complete Section 3 by listing any licenses that your business holds, including additional licenses required to operate in California.
5. Fill in Section 4 with relevant additional business information including your Farm Labor Contractor License or Contractor’s State License Board Number.
6. In Section 5, provide Social Security Numbers for individuals associated with the business. If you prefer not to disclose these numbers, note the alternative identification options available.
7. Review Section 6, answering questions about your business operations. Be sure to explain any 'yes' answers in the remarks section.
8. In Section 7, declare if the business or any principal has declared bankruptcy in the last seven years, providing necessary details.
9. Proceed to Section 8 to indicate if the operation was part of an existing business that was acquired, revealing percentage acquired and previous ownership details.
10. Section 9 focuses on management practices. Indicate offered programs and practices in place regarding employee support, hiring, and safety.
11. Utilize Section 10 for any remarks that you wish to add regarding your application.
12. Complete Section 11 if this is a brokered account. The broker must fill in their details, affirming that the information provided is accurate and original signatures should be submitted.
13. Once you have filled out all the relevant sections, save the changes, and choose to download, print, or share the form as needed.

Complete your Supplemental Application Form online today to ensure your business is properly covered.