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Workers' Compensation Self-Insurance Groups

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Workers' Compensation Self-Insurance Groups
TDI Form NumberDescriptionFile FormatLanguage
FIN404Workers Compensation Group Self-Insurance Coverage Acknowledgement of Indemnity Agreement
Workers' Compensation Self-Insurance Group (SIG) coverage acknowledgement of indemnity agreement; employer's joint and several liability agreement
PDFEnglish
FIN464Bond of Administrator or Service Company for a Workers' Compensation Self-Insured Group
Format Instructions
PDFEnglish
FIN465Workers Compensation Self-Insurance Group Application
Application for Certificate of Approval to Conduct Workers Compensation Self-Insurance Group (SIG) Business
PDFEnglish
FIN466Workers Compensation Self-Insurance Group (SIG) Application Checklist
Application checklist for workers compensation Self-Insurance Groups (SIG)
PDFEnglish
FIN467Workers Compensation Self-Insurance Group (SIG) Employer Membership Form
Employer membership form for workers compensation Self-Insurance Groups
PDFEnglish
FIN468Workers Compensation Self-Insurance Group (SIG) Notification Form
Mandatory notification to the commissioner of insurance regarding any one of a variety of possible changes that a workers compensation Self-Insurance Group (SIG) makes
PDFEnglish
FIN469Workers Compensation Self-Insurance Group (SIG) Termination of Certificate of Approval Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) to apply for termination of its certificate of approval
PDFEnglish
FIN470Workers Compensation Self-Insurance Group (SIG) Merger Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) to merge with another SIG engaged in the same or similar type of business
PDFEnglish
FIN471Workers Compensation Self-Insurance Group (SIG) 5% Investments
Instruction for a workers compensation Self-Insurance Group (SIG) regarding authorized investments for meeting minimum capital and surplus and reserves
PDFEnglish
FIN472Workers Compensation Self-Insurance Group (SIG) Hazardous Financial Condition Notice
Instructions and checklist for a workers compensation Self-Insurance Group (SIG) should it become insolvent or discover a hazardous financial condition
PDFEnglish
FIN473Workers Compensation Self-Insurance Group (SIG) Changes to Administrator/Service Company Agreements Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) if there are any changes to agreements or new agreements are entered into with an administrator/service company
PDFEnglish
FIN474Workers Compensation Self-Insurance Group (SIG) Change in Security for Incurred Liabilities Form
Security deposit instructions for a workers compensation Self-Insurance Group (SIG)
PDFEnglish
FIN475Workers Compensation Self-Insurance Group (SIG) Change in Performance or Fidelity Bond Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) for a change in performance or fidelity bond
PDFEnglish
FIN476Workers Compensation Self-Insurance Group (SIG) Changes to Corporate Governance Documents Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) to make a change to its corporate governance documents, including By-Laws, Articles of Association, Incorporation, or other documentation used to verify the existence of the SIG and/or Trust
PDFEnglish
FIN477Workers Compensation Self-Insurance Group (SIG) Excess Insurance Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) to establish excess insurance for losses
PDFEnglish
FIN478Workers Compensation Self-Insurance Group (SIG) Financial Pro Forma
Financial Pro Forma for a workers compensation Self-Insurance Group (SIG)
PDFEnglish
FIN479Workers Compensation Self-Insurance Group (SIG) Movement of Books and Records Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) to request to move its books and records out of Texas
PDFEnglish
FIN480Workers Compensation Self-Insurance Group (SIG) Increase or Decrease in Membership Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) if there is an increase or decrease in membership
PDFEnglish

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Translation by WorldLingo