Application To Self Insure Workers Compensation Liabilities | Pdf Fpdf Docx | South Dakota

 South Dakota   Workers Compensation 
Application To Self Insure Workers Compensation Liabilities | Pdf Fpdf Docx | South Dakota

Last updated: 2/20/2024

Application To Self Insure Workers Compensation Liabilities

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Description

APPLICATION TO SELF-INSURE WORKERS' COMPENSATION LIABILITIES. This application is for approval to self-insure workers compensation liabilities from September 1, 2024, to August 31, 2025. If the application is being made after September 1, 2024, the Certificate of Exemption will be valid only from the date of execution until August 31, 2025. A renewal application will be required for self-insurance during the 2024/2025 year. This is an application for employers seeking to self-insure workers' compensation in South Dakota. The attached schedules are to facilitate the submission of proof of solvency and financial ability to compensate under the provision of the Workers' Compensation Law of South Dakota. www.FormsWorkflow.com

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