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Appalachian Underwriters require all policy changes be submitted in writing and placed to the attention of the Endorsement department.  Endorsement requests generally take 3-4 weeks to be processed once all required information is received, but we will be more than happy to check on the status of a request for you at any time.

Be sure to include the following information before mailing or faxing to AUI.

• Attention Edorsements
• Agency Name
• Policy Holder Name
• Policy Number along with Effective Dates of Policy
• Effective Date of Change
• Changes Required along with Reason Why

For Endorsement inquires, please call:  (888) 376-9633, press 1, then ext: 2140


For prompt Commercial Specialty (E&S) electronic support, email:  ESsubmissions@appund.com
Commercial Specialty Fax:  (866) 409-3367


For prompt Workers Compensation electronic support, email:  WCpolicychanges@appund.com
Workers Compensation Fax:  (888) 871-7644

     ACORD 35
     AIG Blanket Waiver Form
     AIG Specific Waiver Form
     Drug Free Credit Application
     Waiver of Subrogation (Not AIG)

Name change, change in ownership, or entity change for Workers Compensation requires an ERM-14 and New Application be submitted.  These changes can not be process until the ERM-14 is completed in full (NCCI requires this data).

     ERM-14 Form

Waiver of subrogation requires:
If the insured is requiring a waiver of subrogation be added to their work comp policy, please have them complete the appropriate waiver form below and return to our office via fax. AIG has their own specific forms, while the other carriers accept the general waiver form. Please contact our office to check on the availability of waivers per carrier to ensure that the waiver can be endorsed onto the policy. 
    
     AIG Blanket WOS Form 
     AIG Specific WOS Form
     Generic WOS Form


New York:
NY C105.2 Form

Please have the C105.2 form completed through question 3d, and faxed to our office at 888-871-7644 to the attention of the Workers Compensation Renewal Department. Our office will have the form submitted to the carrier and return a copy of the form to your office via fax or email, if provided. We will then have the original form filed either with the carrier, or sent to your office, depending on carrier guidelines. Please make sure the form is legible to ensure prompt handling and issuance.

     NY C105.2 Form 

NY UAIN

If the insured is needing to obtain their NY UAIN, please have the UAIN application completed and mailed to the following address:

  Department of Taxation and Finance and Department of Labor -
  Unemployment Insurance Div. Reg. Sec.
  WA Harrlman State Campus, Bldg. 12
  Albany, NY 12240-0339
    
     NY UAIN Form
    

Officer Inclusion / Exclusions:
Below is a list of available officer inclusion and exclusion forms by state.  These need to be submitted to ensure accuracy on the policy.  If the officers of a company need to be amended, the carriers require an updates application and the appropriate form if applicable. 

The following states only require an updated application to amend officers: Arkansas, Iowa, Illinois, Louisiana, Missouri (Except for LLC), Nevada, North Carolina, and Utah. 

Alabama, Connecticut, Florida, Kansas, and Tennessee all require the exclusion forms to be approved by the state, they will stamp these forms and the carrier requires a copy of the state stamped forms.  

     Alabama Exclusion
     Alaska Exclusion
     Colorado Exclusion
     Connecticut Exclusion
     Connecticut Sole Proprietor Inclusion
     FL EXCLUSION FORM
     FL INCLUSION FORM
     FL NOTICE OF REVOCATION OF EXCLUSION
     FL REVOCATION OF INCLUSION
     Georgia Inclusion Exclusion
     Iowa Exclusion
     Kansas Exclusion
     Kansas Revoke Exclusion
     Kansas Sole Proprieter, Partner, LLC Inclusion
     Kansas Sole Proprieter, Partner, LLC Revocation of Inclusion
     Maryland Exclusion
     Maryland Inclusion
     Massachusetts Exclusion
     Michigan Exclusion
     Mississippi Exclusion
     New Hampshire Exclusion
     New Mexico Exclusion
     New York Exclusion
     New York Inclusion Sole Proprietor, Partner, LLC
     New York Nonprofit Exclusion
     New York Revoke Exclusion
     New York Revoke Nonprofit Exclusion
     South Carolina Exclusion
     Tennessee Exclusion
     Tennessee Revoke Exclusion
     Tennessee Sole Proprieter, Partner, LLC Inclusion
     Vermont Exclusion
     Virgina Exclusion
     Virgina Revoke Exclusion
 

If you have any questions regarding the forms, or need a copy of the Kentucky exclusion form, please contact the endorsement department by calling:  (888) 376-9633, press 1, then ext: 2140


For Endorsement inquires, please call:  (888) 376-9633, press 6 or Fax: (866) 206-2343