Workers' Compensation Self-Insurance Groups
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| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| FIN404 | Workers Compensation Group Self-Insurance Coverage Acknowledgement of Indemnity Agreement Format Instructions | English | |
| FIN464 | Bond of Administrator or Service Company For A Workers' Compensation Self-Insured Group Format Instructions | English | |
| FIN465 | Workers Compensation Self-Insurance Group Application Application for Certificate of Approval to Conduct Workers Compensation Self-Insurance Group (SIG) Business | English | |
| FIN466 | Workers Compensation Self-Insurance Group (SIG) Application Checklist Application Checklist for Workers Compensation Self-Insurance Groups (SIG) | English | |
| FIN467 | Workers Compensation Self-Insurance Group (SIG) Employer Membership Form Employer Membership Form for Workers Compensation Self-Insurance Groups | English | |
| 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 Makes | English | |
| 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 | English | |
| 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 | English | |
| 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 | English | |
| FIN472 | Workers Compensation Self-Insurance Group (SIG) Hazardous Financial Condition Notice Instruction and Checklist for a Workers Compensation Self-Insurance Group (SIG) should it become Insolvent or Discover a Hazardous Financial Condition | English | |
| 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 | English | |
| 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) | English | |
| 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 | English | |
| FIN476 | Workers 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 | English | |
| 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 | English | |
| FIN478 | Workers Compensation Self-Insurance Group (SIG) Financial Pro Forma Financial Pro Forma for a Workers Compensation Self-Insurance Group (SIG) | English | |
| 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 | English | |
| 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 | English |
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