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Societies Insurance

Group Self-Insurance Fund insurance

Group Self-Insurance Fund · Online application

Section I. Applicant Information

Questions 1 to 13 of the Group Self-Insurance Fund supplemental application. Fields marked * are required.

Is the mailing address different from the physical address?

Cell / Business / Home

Cell / Business / Home

Do you have a website?

Type of entity

Good to know: when you press Save and continue, we save your answers and email a private link to the email address you entered above, so you can come back and finish on any device within 30 days. You will get this email even if you finish today; there is nothing you need to do with it.

Your answers are saved every time you move to another section. Need a break? Press Save and finish later and we will email you a private link (kept for 30 days).

Questions? Call 800-616-3490 or email quote@societiesinsurance.com.

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