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(6) Workers Compensation Law requires that businesses seeking state issued permits demonstrate that they have appropriate Workers Compensation Insurance (WCI). Indicate your WCI status: Insured with Name of Insurance Provider Self Insured Exempt from WCI (7) The undersigned applies for a license to operate a retail food store at this lo.

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How to fill out the NY FSI 302 online

Filling out the NY FSI 302 form is essential for obtaining a retail food store license in New York. This guide will provide you with clear, step-by-step instructions to ensure your application is completed accurately and efficiently.

Follow the steps to complete the NY FSI 302 form online.

  1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online document editor.
  2. Begin by filling in the applicant's details in section (1) including the individual owner name, partnership, or full corporation name, along with the county, trade name, business telephone number, and address.
  3. If applicable, specify an optional mailing address in section (2). This is where correspondence related to your application can be sent.
  4. Provide your identification number in section (3), choosing either the federal ID number or social security number as required.
  5. In section (4), list all sole proprietors and corporate officers or, if applicable, partners or members of the business. Ensure to include their titles, contact addresses, email addresses, and dates of birth.
  6. Complete section (4a-c) with the principal office address, state of incorporation, and date of incorporation. Indicate whether you are a foreign entity in section (4d) and provide the necessary information if applicable.
  7. In section (5), list all potentially hazardous foods that will be sold at your retail food store. This includes items that require specific safety measures.
  8. Address section (6) by indicating your workers' compensation insurance status, including the insurance provider if you are insured, or indicate if you are self-insured or exempt.
  9. In section (7), read and acknowledge the statements concerning the compliance and operation of the retail food store by providing an original signature and title.
  10. After reviewing all entries for accuracy, save your changes, download the form, or print it for submission. You may also opt to share the completed form as necessary.

Start filling out your NY FSI 302 form online today to ensure a smooth application process.

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NY FSI 302
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