If your company has retrospective policies, you will need to include the total surcharge amount for these policies on the appropriate line of the online Second Injury Fund Surcharge report form. In addition, separate documentation MUST be sent to the Division (either by e-mail or mail) to support the surcharge amount entered on the quarterly surcharge report form for the retrospective policies. This documentation must include the policy year, premium amount, surcharge rate, and surcharge amount.
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