Insurance institutions

Forms for insurers and other entities

Certificate of authority application

This application applies to the following groups:

  • Domestic home protection
  • Domestic insurer
  • Foreign or alien home protection insurer
  • Health care service contractor (HCSC)
  • Insurance companies
  • Instructions for workers’ compensation carriers

Affidavit for lost certificate of authority: Word

Amended certificate of authority application

Application for reservation of name: Word

Health Care Service Contractor bond: Word 

Home protection insurer bond: Word

Organizational bond: Word

Permit to organize insurer with or without capital stock application:Word

Change of registered office and registered agent by insurer: Word  

Forms A though F

  • Statement regarding the acquisition of control of merger with a domestic insurer - Form AWord
  • Insurance holding company system annual registration - Form B:Word
  • Summary of registration statement - Form CWord
  • Prior notice of a transaction - Form DWord 
  • Pre-acquisition notification form: Form E
  • Enterprise risk report - Form FWord

Multiple employer welfare arrangement 

  • Certificate of multiple employer welfare arrangement application Word 
  • Multiple employer welfare arrangement bond Word

Rating organizations

  • Rating organization license application: Word
  • Rating organization amended license application: Word

Security deposit

  • Security deposit release general request: Word | PDF
  • Security deposit release request for workers' compensation: Word | PDF

Tax forms

Other forms

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Key links

iReg reporting system
UCAA​​​

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