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To receive accurate and up-to-date information regarding your potential Workers’ Compensation Insurance coverage, please provide us with the following:

• Number of business locations and the number of employees at each location
• 3 year payroll audits*
• 5 year loss runs by year*
• 5 year premium history*

* Depending on how long the company has been in the business ** Note: If you consider obtaining an individual insurance, i.e. non-group one, in addition to the above, please complete " NYSIF: Application for New York Workers' Compensation and Employers' Liability Insurance"