PDF applications and forms may be downloaded and printed. In order to view or print these applications, you must install Adobe Acrobat Reader on your computer.

Get Acrobat Reader
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


Applications
DOC PDF
Excess Workers' Compensation
Employee Concentration Sup. Info
Large Deductible WC
Aircraft
Credit Risk
Excess Unemployment Compensation
Electrical Supplemental
Hospital Supplemental
Loss Portfolio Transfer
Surety Bond
TEXcess Application
Contractor's Supplemental Questionnaire
Vehicle Supplemental
Watercraft Supplemental
Third Party Administrator
Fraud Warning Statement
Claim Forms
DOC PDF
First Report
Supplemental Report
SCHIP REPORTING
MMSEA SCHIP Reporting Notice
Auto/GL- First or Supplemental report
Request for Reimbursement
DOC PDF
Aggregate Claim
Specific Claim
Specific Claim (pro-rated claim expense)
Brochures
DOC PDF
Safety National Corporate Brochure
Excess Workers' Compensation
Large Casualty Program
Loss Portfolio Transfer
Construction
MAP Client Services
TEXcess Brochure
How to Self-Insure
Ask Best Doctors Program
Best Doctors CatCare Program
Assumed Reinsurance
Wisconsin Large Risk Alternative Rating Option Questionnaires
DOC PDF
Surety Bond
Aircraft Supplemental
Watercraft Supplemental
Electrical Exposure Supplemental
Unemployment Compensation
Workers' Comp Questionnaire
Hospital Health Care Supplemental
Employee Concentration Info
Credit Risk
Approved Service Organization
Vehicle Supplemental
Webinars
FLASH
Maximize Your Resources to Manage High Exposure Claims