Forms
The Ohio Department of Insurance has approved these forms for Member Company use. Please refer to the OMSIUA Procedural Guide for more information.
OMSIUA Coverage
Mine Subsidence Insurance Coverage Form (OH-MSI-2)
Download PDFOffer of Mine Subsidence Coverage
Required Offer for Optional Counties (OH-MSI-1)
Download PDFOMSIUA Application
Mine Subsidence Insurance Application for Optional Counties (OH-MSI-3)
Download PDFCombined Offer and Application
Offer and Application for Mine Subsidence Insurance in Optional Counties (OH-MSI-4)
Download PDFAssumption Agreement
Reinsurance Agreement for Insurers Writing Property Coverages in Ohio
Download PDFExemption Request
Form Filed with Ohio Department of Insurance to Request Exemption from Participation
Download PDFYou may use the file upload process below to submit your forms, or you may email them to OMSI@ohiofairplan.com.