Request an Application for Insurance by Mail
Complete the form below to request an application for workers' compensation insurance
be sent to you by mail. Please note that this form
is not an application for workers' compensation insurance coverage and that your
submission of information does not constitute coverage. For your convenience,
you may also download
[212 k] the application forms. If you have any questions, please contact the
Customer Service Center.
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The State Compensation Insurance Fund is organized as a public enterprise fund and
is a division within the California Department of Industrial Relations. The State
Compensation Insurance Fund is not a branch of the State of California.