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You are here: www.tdi.texas.gov . forms . form23

Workers' Compensation Self-Insurance Groups

This is one of several pages linking to a central repository of forms used by TDI customers. Use the search or Forms by Type links on the Forms Home Page or scan through our form listings.

Workers' Compensation Self-Insurance Groups
TDI Form Number Description File FormatLanguage
FIN404
Workers 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
FIN464
Bond of Administrator or Service Company for a Workers' Compensation Self-Insured Group
Format Instructions
PDFEnglish
FIN465
Workers Compensation Self-Insurance Group Application
Application for Certificate of Approval to Conduct Workers Compensation Self-Insurance Group (SIG) Business
PDFEnglish
FIN466
Workers Compensation Self-Insurance Group (SIG) Application Checklist
Application checklist for workers compensation Self-Insurance Groups (SIG)
PDFEnglish
FIN467
Workers Compensation Self-Insurance Group (SIG) Employer Membership Form
Employer membership form for workers compensation Self-Insurance Groups
PDFEnglish
FIN468
Workers 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
FIN469
Workers 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
FIN470
Workers 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
FIN471
Workers 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
FIN472
Workers 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
FIN473
Workers 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
FIN474
Workers Compensation Self-Insurance Group (SIG) Change in Security for Incurred Liabilities Form
Security deposit instructions for a workers compensation Self-Insurance Group (SIG)
PDFEnglish
FIN475
Workers 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
FIN476
Workers Compensation Self Insurance Group Changes to Corporate Governance Documents Checklist
Checklist for a workers compensation Self Insurance Group 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
FIN477
Workers Compensation Self-Insurance Group (SIG) Excess Insurance Checklist
Checklist for a workers compensation Self-Insurance Group (SIG) to establish excess insurance for losses
PDFEnglish
FIN478
Workers Compensation Self-Insurance Group (SIG) Financial Pro Forma
Financial Pro Forma for a workers compensation Self-Insurance Group (SIG)
PDFEnglish
FIN479
Workers 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
FIN480
Workers 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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Last updated: 09/18/2014

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Translation by WorldLingo


Translation by WorldLingo