Forms

 

All of the forms below are in Portable Document Format (PDF) and in Word format to ease viewing printing, and downloading.
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Application for Self Insurance
 
 
2008 Member Information Update Forms
Form for Companies Actively Self-Insured

Form for Companies That Have Cancelled Self-Insurance

  Surety Bond
Instructions
Approved Form
Letters of Credit
Instructions
Letter of Credit Language
Addition of a Company to an Employer's Self-Insurance
 
Sample Indemnification Agreement (To Accompany Application for Waiver)
 
Georgia Endorsements for Excess Insurance
Cancellation Endorsement - Ace American Insurance Company

Cancellation Endorsement - Associated Electric & Gas Insurance
Services (AGEIS)
Cancellation Endorsement - Electric Insurance Company
Cancellation Endorsement - Hartford
     
Cancellation Endorsement - Midwest Causalty

Cancellation Endorsement - New York Marine and General Ins Co

Cancellation Endorsement - Safety Nat'l Casualty Corp.
Cancellation Endorsement - XL Specialty Insurance Co