New York Stockholder of Corporation Applying for License to Represent Self-Insurers is a type of New York business entity that allows a corporation to represent itself as a self-insurer in the state of New York. The corporation must have at least one New York resident stockholder, meet certain financial requirements, and obtain a special license from the New York State Department of Financial Services. The license allows the corporation to self-insure and provide coverage for liabilities, such as personal injury or property damage. The license also requires the corporation to comply with all applicable laws and regulations, including filing annual financial statements. The two types of New York Stockholder of Corporation Applying for License to Represent Self-Insurers are: 1. Individual Stockholder: This type of stockholder is an individual who owns at least one share of the corporation's stock and is a resident of the state of New York. 2. An institutional stockholder: This type of stockholder is usually a bank, insurance company, pension fund, or other institutional entity that owns at least one share of the corporation's stock and is a resident of the state of New York.
New York Stockholder of Corporation Applying For License To Represent Self-Insurers
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Accepted Forms: U26.3 ? Certificate of Workers' Compensation Ins (NYS Insurance Fund only)
SI-12 (7/09) Affidavit Certifying That Compensation Has Been Secured. Employers with Board-approved self-insurance for workers' compensation. Filed with the government agency issuing a permit, license or contract. The SI-12 must be completed by the Board's Self-Insurance Office and approved by the Board's Secretary.
If you filed a claim and were assigned a number, you can call (646)264-3000 for information about your claim. If you are a U.S. Department of Labor employee, please call (816)502-0301 for claim status information.
Worker's compensation form completed when the patient first seeks treatment for a work-related illness or injury. It does not contain a signature line. It is filed with State Worker's Compensatin Board/Commission.
New York State employers are required to provide workers' compensation, disability, and Paid Family Leave benefit coverage to their employees. Self-Insurance is a privilege in New York State.