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GALLERY: C 105 2 Form

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All private carriers and their licensed insurance agents that issue NY workers' compensation insurance policies are authorized to issue the form C-105.2 as their Certificate of NYS Workers' Comp Insurance. The NYS State Insurance Fund uses the U-26.3 form as its Certificate of NYS Workers' Comp Insurance. If your client is insured by the State Insurance Fund, please call the Fund at 888-875-5790 and ask for form U-26.3.