Last updated: 6/2/2023
Application For Governmental Self-Insurance {SI-1g}
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Description
DFS-F2-SI-1G - APPLICATION FOR GOVERNMENTAL SELF-INSURANCE. This form is an application for governmental self-insurance, specifically for workers' compensation coverage. It is filed with the Department of Financial Services, Division of Workers' Compensation in Tallahassee, Florida. The form requires the applicant to provide information such as the applicant's name, address, nature of business, contact information, current workers' compensation carrier, and attachments including certification of servicing, application for self-insurance estimated payroll, and a copy of the current experience modification rating. The applicant must certify that all the information provided is true and accurate. www.FormsWorkflow.com
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