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FUBA: Florida United Business Association

Forms Library

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General Forms and Applications

Please note:

(1) The FCBI Supplemental Application and Membership Participation Agreement is not available online.  This form must be an original and come from our office.  To obtain copies, please email the Agency Services Department or call 888-262-4483 and we will be happy to mail you a supply.

(2) We no longer have NCCI rates online.  You may visit their website at www.ncci.com to obtain a copy of the most recent class code rates.

Agency Forms and Applications

If you are an agency seeking to write business with FUBA Workers' Comp, please print and fill out the following forms, include an $85 check made payable to FUBA, and mail to FUBA Workers' Comp, Attention: Marketing Department, Post Office Box 1303, Tallahassee, FL 32302-1303. In addition to the forms below, please be sure to include copies of 220 licenses and proof of $1 million of Errors and Ommisions (E&O) insurance.

 

 

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May 13, 2008

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