These forms are filed with and approved by the Ohio Department of Insurance:
OMSIUA Coverage Form (OH-MSI-2)
Two-part offer and application for optional counties:
Offer of Mine Subsidence Insurance Form (OH-MSI-1)
Application Form (OH-MSI-3)
Combined offer and application for optional counties (may be used in lieu of the above):
Offer and Application Form (OH-MSI-4)
*Click here for instructions for this form.