Website Main Menu


All forms are in PDF format.

Insurance Continuing Education
  Licensee Written Certification
Course Submission Form
Individual Course Submission Packet
 
Insurer Information
     Examination Bureau
Applications
Accredited Reinsurer Application
Medical Care Discount Card Application
UCAA Adding Lines of Authority
UCAA Expansion State Specific
UCAA Primary State Specific
UCAA Retaliatory Statement
  HMO Application
  Motor Club Application
  Premium Finance Co. Application
  Purchasing Group Application
Qualified Charitable Organizations
  Rating Organization Application
  Reinsurance Intermediary Application
  Risk Retention Group Application
Surplus Lines Company Application
Third Party Administrator Application
Viatical Settlement Provider Application
Corporate Changes
  Acquisition or Change in Ownership
  Adding to Lines of Authority
  Address Change
  Bulk Assumption Transfer
  Merger of Insurer
  Name Change
Name Change - Surplus Lines
  Redomestication
Redomestication - Surplus Lines
  Variable Authority
Lists
  Accredited Reinsurer List
  Eligible Surplus Lines Companies
  Surplus Lines Approved Risk List
Annual Fire and Police Forms
  Certification of Taxable Valuation
  Fire Department (Equipment) Report
  Police Finance Report
  Dept. of Administration Fire Finance Form
Misc
Annual Renewals, Filings, & Tax Information
  NAIC Bio - Form11
  Service of Process Form 1042-00-INSURER
  Service of Process Form - SL
Service of Process PG & RRG
Service of Process Viatical BR
  Service of Process Viatical PR
Surplus Lines Forms
MT L&H Guaranty Assoc. Summary

You will need Adobe Acrobat Reader
to view all the documents listed here.
 


Insurance Investigations
  Suspected Fraud Claim
Insurance Rates and Forms
PPACA Uniform Compliance
General Information
  General Procedures
Certification Form
Long Term Care Insurance Partnership
  Life & Disability Filing Instructions
  Form Filing Reference List
  Life & Disability Transmittal WS
  P & C Rate Review Checklist
P & C Form Review Checklist
  Loss Cost Forms
 
Insurance Licensing
  *Business Entity (agency) licenses automatically renew in December, at no charge, if the affiliated producer’s license is active.
Adjuster Licensea
  Business Entity - Car Rentala
  Non-Resident Business Entity Licensea* Important
  Resident Business Entity Licensea*
  Certification/Clearance Letter Request Form
  Consultant Licensea
Long-Term Care Training Licensee Compliance Reporta
  Non-Resident Individual Producer Licensea Important
  Resident Individual Producer Licensea
  Surplus Line Producer's Licensea
Motor Club Salesman or Agenta
  aContains application and instructions
*Business Entity (agency) licenses automatically renew in December, at no charge, if the affiliated producer’s license is active.
 Viatical Settlement Broker Information
  Notification by Life Producer to act as Viatical Broker
  Viatical Settlement Broker Annual Reporting Forms
  Non-Life Licensed Viatical Broker Application
Securities
Uniform Registration Form U1
Uniform Registration Form U2
Uniform Registration Form U4
  Uniform Registration Form U5
  Uniform Form U-SB
  Uniform Application to Offer or Sell Living Trust

Uniform Application - Schedule A

  Uniform Application - Schedule B
  Exemption From Registration
(30-10-105(8)(b). MCA
  Uniform Notification - Multi-level Distribution Companies
  Report of Securities Sales
Securities Complaint Form