Workers Compensation Applications

We look forward to the opportunity to provide you a competitive solutions for your Workers Compensation business. Please fill out the appropriate application below to receive a timely quote from one of our many Workers Compensation  markets. If you don’t see the application or supplement you need, please contact one of the underwriters or other staff listed on the Worker’s Compensation page.

Please note, if you are having any issues with the below application, please:

1. Print a blank application and complete it manually. The “Print Blank” is located directly above the application in the right hand corner.
2. Contact Rob Starcher, TAGA Marketing at 512-531-1744 or and let him know the issue you’re having.

Ownership Form
Service Lloyds New Venture Form
Acord 130
Employers First Report of Injury
Confidential Request for Information (ERM-14)
Deductible Notice of Election DNE-1_1-97good