NY State Statutory Disability Insurance

Groups of Under 50 Lives

  NATIONAL
BENEFIT
LIFE *
GUARDIAN ZURICH STANDARD
SECURITY
HARTFORD
  M     F
1   -   49
M     F
1   -   49
M     F
1   -   25
M    F
1  -  9
M   F
1  -  49
Annual in Advance   18.00  54.60 28.21  61.27 19.92   45.36 19.92  45.36 25.24  55.40
Partner or Prop 114.00 68.86 84 112.32 94.50
Minimum Annual Premium $80 $60 NONE $60 $45
 
Quarterly
in Arrears
10   -   49 10   -   49 26   -   49 10 - 49 1  -  49
Per Month 2.90    6.35 2.60   5.75 2.30   4.95 2.29  5.04 2.49   5.08
Partner or Prop 9.50 5.74 7.00 9.36 7.88
Minimum Quarterly Premium $20 $15 NONE $16 11.25
   
Prepay
Required
NO NO NO NO NO

*   Home Office: New York, NY

To apply for coverage, Please complete Application:

Broker Submitting Request: Licensed?

First Name:   City  
Last Name:   State  
Company: Zip  
Street Address 1:   Phone#:  
Street Address 2: Fax#:
    E-Mail:  
Employer Name:   Street:

 

City, State, Zip:

   

Employer Phone Number:

   

Unemployment Insurance Number

    

  (or Unassigned)

S.S. or Fed Tax ID Number

      (Mandatory)
Nature of Business:

  

 
Form of Organization:

               

 
No. of Employees
     to be insured:

 Male:

Female:

Desired Effective Date of Coverage:

 

 
Previous DBL Carrier:

 

 
Termination Date:

 

 
Name of Workers Comp Carrier:

 

 
Insurance Company Desired:

Additional Employers to be included as Covered Employers:
Remarks:
Please confirm:
         
Do you wish to Bind Coverage? 

   
New to this Web Site?
           We cannot bind coverage for you without a copy of your license.
              Please FAX a copy of your license to us at:  (631) 265-7054

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