Microsoft Word documents can be downloaded, saved, and filled out on your computer.
1. Click on the link, download the document and save it on your computer.
2. To complete an application, bring the document up in Word and tab through the fields. If you need to skip a field, just tab through it. To move back a field, hold down the shift key and tab. You can also "click" into any field using your mouse.
3. If you are submitting an application for Excess Workers' Compensation or Large Deductible Excess Workers' Compensation on a form other than the Safety National Application, please complete our Fraud Warning Statement (available from the list below) and submit it with your other documentation.
If you have any questions, problems or suggestions please contact:
Karla Antrobus
Business Development Information Manager
888-995-5300
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| Excess Workers' Compensation |
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| Employee Concentration Sup. Info |
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| Large Deductible WC |
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| Aircraft |
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| Credit Risk |
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| Excess Unemployment Compensation |
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| Electrical Supplemental |
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| Hospital Supplemental |
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| Loss Portfolio Transfer |
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| Surety Bond |
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| TEXcess Application |
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| Contractor's Supplemental Questionnaire |
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| Vehicle Supplemental |
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| Watercraft Supplemental |
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| Third Party Administrator |
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| Fraud Warning Statement |
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| First Report |
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| Supplemental Report |
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| SCHIP REPORTING |
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| MMSEA SCHIP Reporting Notice |
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| Auto/GL- First or Supplemental report |
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Request for Reimbursement |
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PDF
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| Aggregate Claim |
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| Specific Claim |
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| Specific Claim (pro-rated claim expense) |
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DOC
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PDF
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| Safety National Corporate Brochure |
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| Excess Workers' Compensation |
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| Large Casualty Program |
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| Loss Portfolio Transfer |
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| Construction |
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| MAP Client Services |
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| TEXcess Brochure |
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| How to Self-Insure |
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| Ask Best Doctors Program |
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| Best Doctors CatCare Program |
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| Assumed Reinsurance |
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Wisconsin Large Risk Alternative Rating Option Questionnaires |
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PDF
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| Surety Bond |
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| Aircraft Supplemental |
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| Watercraft Supplemental |
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| Electrical Exposure Supplemental |
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| Unemployment Compensation |
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| Workers' Comp Questionnaire |
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| Hospital Health Care Supplemental |
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| Employee Concentration Info |
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| Credit Risk |
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| Approved Service Organization |
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| Vehicle Supplemental |
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FLASH
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| Maximize Your Resources to Manage High Exposure Claims |
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