Need States' Application Forms?

You can download States' Application forms by just "right clicking" your mouse on the blue arrows below and choosing the menu instructions to download the chosen document to the file location you select on your computer. Simply download the appropriate application form(s), complete it based on the instructions on the form and submit it according to the instructions on the application. States will take it from there!

States' PRIMARY Application Form
(file size: 474 Kb)
(REQUIRED FOR ALL NEW BUSINESS AND EVERY THIRD YEAR ON RENEWALS)
(A separate application is required for any public school operations that are part of the public entity applying for insurance from States. See that application listed below. Supplemental application information may also be required. Please check with States' Underwriting Dept. for assistance.)

NOTE: This States Application Form is provided on an MS Word template that allows completion of the form information fields "electronically" using a computer with MS Word installed. If you do not have MS Word available to you, you can download and print out this application in order to complete it manually by clicking HERE.


States' RENEWAL Application Form
(file size: 387 Kb)
(INTENDED FOR USE IN RENEWAL PERIODS BETWEEN THE NEW BUSINESS APPLICATION (FIRST YEAR) AND THE SUBSEQUENT TWO RENEWAL YEARS. EVERY THIRD RENEWAL YEAR, AN ORIGINAL, "PRIMARY" APPLICATION FORM SHOULD BE COMPLETED, SUBJECT TO UNDERWRITING REQUIREMENTS.)

NOTE: This States Application Form is provided on an MS Word template that allows completion of the form information fields "electronically" using a computer with MS Word installed. If you do not have MS Word available to you, you can download and print out this application in order to complete it manually by clicking HERE.

States' PUBLIC SCHOOLS APPLICATION FORM
(file size: 360 Kb)
THIS APPLICATION FORM IS FOR USE BY PUBLIC SCHOOLS WHERE NO OTHER MUNICIPAL OPERATIONS ARE INVOLVED ---- ONLY THE SCHOOL OPERATIONS. THE FORM IS DESIGNED TO SIMPLIFY THE APPLICATION PROCESS FOR PUBLIC SCHOOLS AND MINIMIZE THE NEED TO COMPLETE APPLICATION INFORMATION THAT DOES NOT APPLY. IF OTHER PUBLIC ENTITY OPERATIONS EXIST BEYOND THOSE OF THE PUBLIC SCHOOL, THE MAIN APPLICATION FORM SHOULD ALSO BE USED (See above).

NOTE: This States Application Form is provided on an MS Word template that allows completion of the form information fields "electronically" using a computer with MS Word installed. If you do not have MS Word available to you, you can download and print out this application in order to complete it manually by clicking HERE.

States' Supplementary Application Forms:

Application Supplement for Sexual & Physical Abuse Information:
Click HERE for MS Word Template -- Can be completed in MS Word OR

Click HERE for a PDF version that can be printed out and completed manually.

Application Supplement for Day Care and/or Nursery Operations:
Click HERE for MS Word Template -- Can be completed in MS Word OR

Click HERE for a PDF version that can be printed out and completed manually.

Application Supplement for 15 Passenger Van Operations:
Click HERE for MS Word Template -- Can be completed in MS Word OR

Click HERE for a PDF version that can be printed out and completed manually.

(The material may take a few minutes to download, depending on your computer system's capabilities.)

Comments regarding this Website should be directed to: StatesAdmin@berkleyrisk.com