Company Licensing Forms & Applications
Insurance Company Licenses
Reinsurers
- Reinsurer Application [pdf]
Auto Clubs or Associations
- Application for Certificate of Authority [CORE]
- Application for Auto Club Agent [pdf]
- Proof of Surety Bond [pdf]
- Appointment of Agent for Service of Process [pdf]
- Biographical Affidavit - Form 11 [UCAA]
Charitable Gift Annuities
- Charitable Gift Annuity Application Packet [CORE]
- Charitable Gift Annuity Issuer Annual Report Form [pdf]
County Mutual Insurance Companies
Discount Plan Operators
Employee Leasing
- Employee Leasing Licensee Application [CORE]
- Employee Leasing Renewal Application [CORE]
- Guaranty Agreement Form [pdf]
External Review Organizations
- External Review Organizations Application Packet [pdf]
- External Review Organizations Approved List [pdf]
Health Carrier Grievance Reporting Forms and Procedures
- Instructions and Packet [pdf]
- Instructions and Packet [Word]
MEWA
- MEWA Application [pdf]
Pharmacy Benefits Manager ("PBM") Licensing Packet
Prepaid Limited Health Service Organizations
Preferred Provider Organizations
Risk Purchasing Groups
- Application for Risk Purchasing Group [CORE]
- RPG Secretary's Certificate [pdf]
- RPG Service of Process Form [pdf]
Risk Retention Groups
Tax Preparation Service Companies
Third Party Administrators
- Life and Health Third-Party Administrators Packet [CORE]
- Workers Compensation Third-Party Administrators Packet [CORE]
Utilization Review Organizations
Vehicle Protection Product
- Warrantor's Initial Registration [pdf] (Vehicle Protection Act)
- Warrantor's Registration Renewal [pdf]
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