Get Ny Fs-100 2010-2025

The NY FS-100 form is an application for a certificate of self-insurance in New York State. This guide provides a clear and structured approach to completing the form online, ensuring you submit all necessary information efficiently and accurately.

Follow the steps to fill out the NY FS-100 form online.

1. Click ‘Get Form’ button to access the form and open it in your browser.
2. Begin by entering your applicant information. Provide the full name of the applicant, the mailing address, city, state, ZIP code, phone number, fax number, and email address.
3. Indicate whether this is an original application or a renewal by checking the appropriate box.
4. Next, answer the question about your current self-insurance status in New York State. If you are self-insured, provide your certificate number.
5. Indicate the number of vehicles you plan to register under the self-insurance certification, and remember to attach a detailed list of these vehicles.
6. Answer if any of the vehicles are tow trucks, and if so, provide the number of tow trucks to be registered.
7. State whether any of the vehicles will be used for transporting passengers and provide the required details based on your answer.
8. Complete the application fees section, noting that a fee of five dollars is required for each vehicle to be registered.
9. Fill out the contact administrator information and claims liaison information where additional details about the contact persons for this application are requested.
10. Proceed to complete sections E and F for calculations involving asset and equity, and make sure to perform correct mathematical operations as instructed.
11. Affirm your application through the section requiring sign-off from an independent certified public accountant, if applicable.
12. Continue to the accident and claims experience section, detailing relevant claims experience over the past four years.
13. Complete the excess insurance policy section, ensuring you attach the required documentation.
14. Finally, submit the declaration by signing and dating the form, ensuring all required signatures are present before saving your changes, downloading, printing, or sharing the completed form.

Start completing your NY FS-100 form online today to streamline your self-insurance application process.