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) - Current Version
Mine Subsidence Insurance Coverage Form (OH-MSI-2) - New Version Effective 01/01/2027
Offer of Mine Subsidence Coverage
Required Offer for Optional Counties (OH-MSI-1)
OMSIUA Application
Mine Subsidence Insurance Application for Optional Counties (OH-MSI-3)
Combined Offer and Application
Offer and Application for Mine Subsidence Insurance in Optional Counties (OH-MSI-4)
Assumption Agreement
Reinsurance Agreement for Insurers Writing Property Coverages in Ohio - Current Version
Reinsurance Agreement for Insurers Writing Property Coverages in Ohio - New Version Effective 01/01/2027
Exemption Request
Form Filed with Ohio Department of Insurance to Request Exemption from Participation
You may use the file upload process below to submit your forms, or you may email them to OMSI@ohiofairplan.com.