Form RM-SOSI "Request for Statement of Self-insurance" - Hawaii

What Is Form RM-SOSI?

This is a legal form that was released by the Hawaii Department of Accounting & General Services - a government authority operating within Hawaii. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on January 1, 2007;
  • The latest edition provided by the Hawaii Department of Accounting & General Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form RM-SOSI by clicking the link below or browse more documents and templates provided by the Hawaii Department of Accounting & General Services.

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Download Form RM-SOSI "Request for Statement of Self-insurance" - Hawaii

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TO:
RISK MANAGEMENT OFFICE
Fax number: 808-586-0553
FROM:
REQUEST FOR STATEMENT OF SELF-INSURANCE
NAME OF SCHOOL/DIVISION/AGENCY
NAME
DATE
CONTACT NUMBER
FAX NO.
NAME OF ACTIVITY:
ADDRESS OF ACTIVITY:
DATE OF ACTIVITY:
TIME OF ACTIVITY:
TO:
FROM:
NUMBER OF PARTICIPANTS AS APPLICABLE:
PLEASE PROVIDE A BRIEF EXPLANATION OF THE ACTIVITY AND HOW IT RELATES TO THE DEPARTMENT’S MISSION:
PLEASE ADDRESS THE STATEMENT OF SELF-INSURANCE TO:
NAME:
ADDRESS:
FAX NUMBER:
RM-SOSI (1/07)
TO:
RISK MANAGEMENT OFFICE
Fax number: 808-586-0553
FROM:
REQUEST FOR STATEMENT OF SELF-INSURANCE
NAME OF SCHOOL/DIVISION/AGENCY
NAME
DATE
CONTACT NUMBER
FAX NO.
NAME OF ACTIVITY:
ADDRESS OF ACTIVITY:
DATE OF ACTIVITY:
TIME OF ACTIVITY:
TO:
FROM:
NUMBER OF PARTICIPANTS AS APPLICABLE:
PLEASE PROVIDE A BRIEF EXPLANATION OF THE ACTIVITY AND HOW IT RELATES TO THE DEPARTMENT’S MISSION:
PLEASE ADDRESS THE STATEMENT OF SELF-INSURANCE TO:
NAME:
ADDRESS:
FAX NUMBER:
RM-SOSI (1/07)