NYSCA Insurance Plan Applications

Print Applications

• General Liability/Medical Expense Enrollment Form (coverage effective 02/01/2016-01/31/2017)
• General Liability/Medical Expense Enrollment Form (coverage effective 02/01/2017-01/31/2018)
• Optional Coverages Questionnaire (D&O, Crime and Equipment)

Please note that the computer you are using must have Adobe Acrobat Reader version 4.0 or higher. If your computer does not have this program, you can click on the link below and download it for free.

We accept faxed checks. Click here for special instructions on how to fax a check.