Policy Information

NOTE: To submit this document online, instead of by mail, you must have a valid NYS driver's license or NYS ID Card and an email address. You will not be able to complete the online submission process without providing information from your valid NYS License or NYS ID card. If you do not possess a valid NYS license or NYS ID card, please submit this form by mail.

I agree to the New York State Insurance Fund User Agreement and Privacy Policy.

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