Insurer financial regulation

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

Amended certificate of authority application

Application for reservation of name: Word | PDF

Health Care Service Contractor bond

Home protection insurer bond

Organizational bond

Permit to organize insurer with or without capital stock application

Change of registered office and registered agent by insurer 

Forms A though F

  • Statement regarding the acquisition of control of merger with a domestic insurer - Form A
  • Insurance holding company system annual registration - Form B
  • Summary of registration statement - Form C
  • Prior notice of a transaction - Form D
  • Pre-acquisition notification form: Form E
  • Enterprise risk report - Form F

Multiple employer welfare arrangement 

Rating organizations

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

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