By signing this form the self insurer agrees to participate in the Minnesota Assigned Claims Plan. Agreement by Parent company must be completed when it is necessary for the parent to assume the liabilities of a subsidiary. This normally occurs when a subsidiary entity is applying for self insurance and they are using their parents financial statements as evidence of satisfactory financial strength. Notice is the form that states the applicants Minnesota Tax Identification Number and Social Security Number. This MUST be included along with the application.
Bond is the form of the surety bond that is required in order to qualify as an auto self-insurer.
A new form is required each year. Agreement and Acknowledgement must be completed with the initial application and when a new signature is required. By signing this form the self-insurer agrees to participate in the Minnesota Assigned Claims plan. Notice is the form that state the applicants Minnesota Tax Identification number and Social Security number. This must be included along with the application.