May 25, 2022
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Home
The Three C’s
Program Highlights
Think Safety Intro
Why Choose MATSIF
Testimonials
Member Profiles
About
Commitment
About MATSIF
Mission
Administration
Program
Cost Savings
Program Overview
Refunds
Loss Control Program
Think Safety Program
Claims Management
Employment
Request Quote
News
Contact
Members
Company Name
*
MATSIF #
*
Reporting Payroll for the Month of
CODE
CLASSIFICATIONS
TOTAL NUMBER OF EMPLOYEES
NUMBER EMPLOYEES SPLITTING PAYROLL
PREMIUM BASE
RATE (per $100 Payroll)
EARNED PREMIUM
Code
Clasification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Code
Classification
Total Number of Employees
Number Employees Splitting Payroll
Premium Base
Rate (per $100 Payroll)
Earned Premium
Total Earned Premium
Experience Modification Rate
*
Subtotal (Multiply Total Earned Premium by Experience Modification Rate)
Add Monthly Expense Constant
Total Due
5% Late Filing Fee
If you are filing this report after the 15th of the month. Please include 5% of the total due for late filing surcharge.
Previous Month Error
Total Amount Due & Paid
Price:
$0.00
Total Number of Employees
Email
*
Phone
*
Billing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Shipping Address
*
Same as Billing Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Payment Option
*
Credit Card
Check
Make your payment directly into our bank account. Please use your MATSIF # and Company Name as the payment reference.
Credit Card
*
American Express
Discover
MasterCard
Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
Expiration Date
Security Code
Cardholder Name
User ID
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