Application To Individually Self-Insure {7}

FORM 7 - APPLICATION FOR EMPLOYER TO INDIVIDUALLY SELF-INSURE. This form is used by employers in South Carolina to apply for permission to self-insure for workers' compensation coverage. The application requires detailed information about the business, including its legal structure, number of employees, previous workers' compensation claims, and current insurance details. Employers must also provide documentation such as audited financial statements, safety program descriptions, and excess insurance quotes. By submitting this form, the employer agrees to comply with the South Carolina Workers' Compensation Commission regulations and provides contact details for claim administration and self-insurance matters. www.FormsWorkflow.com