Get Ny Si-26 2016-2025

This guide provides clear and step-by-step instructions on how to fill out the New York SI-26 form online. Completing this form is essential for political subdivisions or fire districts that wish to secure compensation as self-insurers for their employees.

Follow the steps to successfully complete the NY SI-26 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor for further editing.
2. In the first section, provide the name of the political subdivision or fire district in the designated space for 'Name of Political Subdivision or Fire District'.
3. Next, fill in the address of the political subdivision or fire district in the 'Address' field.
4. Enter the federal tax identification number in the appropriate field.
5. Indicate if a certified copy of the resolution adopted regarding self-insurance is attached by checking the corresponding box. If other documentation is provided, check the alternative box and include a brief explanation.
6. Specify the date when the election to secure compensation was made in the section labeled 'Enter Date'.
7. Indicate the effective date for this election in the 'Enter Effective Date' field.
8. If the employees were previously covered by insurance, provide the name of the insurance carrier and policy number in the 'Previous coverage' section.
9. Choose how you intend to handle compensation matters with employees by ticking either option 'a' or 'b'. If 'b' is selected, provide the name and address of the licensed self-insurers representative.
10. Designate the primary contact for self-insurance matters, including their name, title, address, phone number, and email.
11. Lastly, ensure the form is signed by the appropriate individual and include the date signed alongside their official title and telephone number.
12. After completing the form, you can save the changes, download, print, or share the completed NY SI-26 as necessary.

Begin filling out your NY SI-26 online today to ensure your political subdivision or fire district is properly registered for self-insurance.