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To begin the application process in becoming a member of LAC Self-Insured Fund. Click on the PDF “LAC SIF Pre-application checklist” and complete the form.

LAC SIF Pre-application checklist

If you have questions regarding this form please call. This form does not bind coverage nor does it obtain your membership into the LAC SIF. This form is used only to begin the application process. Once the form is received you will be contacted. You may email, mail, or fax this form to:
3000 Kilpatrick Blvd • Suite 100 • Monroe, LA 71201
Toll Free Phone: 1.800.798.2999
Fax: 318.322.3172