Items needed to complete this form:
- Copy of your current Certifcate of Coverage (COI)
- Declaration Page of Current Policy
- A Loss Run report or No Loss letter on your company letterhead
Please complete this form to the best of your ability. If you are a start up company and do not have a current policy please enter N/A into the fields that do not apply, the items listed above will not apply either. If you have any questions when completing this form, please reach out to Samantha Long at slong@Tilsonhr.com.