Get Si-1a.pdf

Filling out the SI-1a.PDF form is an important step for employers seeking self-insurance status in Florida. This guide provides a clear, step-by-step approach to completing the form online, ensuring you have all the necessary information ready for submission.

Follow the steps to accurately complete the SI-1a.PDF online.

1. Press the ‘Get Form’ button to access the SI-1a.PDF form and open it in your preferred editor.
2. Begin by entering the applicant's name in the designated field, ensuring that the name matches the legal entity applying for self-insurance.
3. In the following section, input the applicant's Federal Employer Identification Number, a vital detail for the processing of your application.
4. Provide the complete address of the principal office. This should include street address, city, state, and zip code.
5. Enter the principal office's telephone number in the next field, ensuring it is a valid and reachable contact number.
6. Attach a list of all subsidiary or affiliated companies under the applicant's self-insurance privilege, indicating ownership percentage and the addresses of each Florida location.
7. Indicate the type of applicant by checking the appropriate box—choose from Corporation, Partnership, Individual proprietorship, or Other.
8. Attach proof of registration if the applicant or subsidiaries are registered Florida corporations, ensuring all documentation is accurate and up-to-date.
9. Identify the employee who will coordinate the self-insurance program by entering their name, title, and address if different from the principal office.
10. Review all information entered for accuracy and completeness before proceeding to save your changes, download, print, or share the form as needed.

Complete your SI-1a.PDF application online today to ensure a smooth self-insurance process.