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Titlesort ascending Last updated Attachments
Form E-811: Renewal of Service Company Permit 09/08/2018 (Tue)
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PDF icon Form E-811 Service Company Renawal952.57 KB
Form E-801: Motor Vehicle Dealer's Notice of Intent 03/06/2018 (Tue)
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PDF icon Form E-801 Motor Vehicle Dealer's Notice of Intent.pdf748.71 KB
Form E-800: Application for Service Company Permit 09/08/2018 (Tue)
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PDF icon Form E-800 Service Company Application1017.23 KB
Form E-800-B: Service Company Biographical List 03/06/2018 (Tue)
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PDF icon Form E-800-B Service Company Application Biographical List.pdf726.83 KB
Form E-711: Purchasing Group List of Insurers and Agents 03/06/2018 (Tue)
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PDF icon Form E-711 Purchasing Group List of Insurers and Agents.pdf638.14 KB
Form E-710: Application for Purchasing Group Registration 03/06/2018 (Tue)
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PDF icon Form E-710 Purchasing Group Application.pdf632.76 KB
Form E-701: Certificate of Public Supervisory Official 01/09/2018 (Tue)
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PDF icon Certificate of Public Supervisory Official Form E-701.pdf1.47 MB
Form E-700: Certificate of Surplus Lines Broker 01/09/2018 (Tue)
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PDF icon Certificate of Surplus Lines Broker Form E-700.pdf1.22 MB
Form E-654: Application for Life Care Provider Permit Change 08/07/2018 (Thu)
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PDF icon Life Care Provider Permit Change E-654.pdf646.21 KB
Form E-653: Checklist for Change from a Provisional Permit to Life Care Provider Permit 02/06/2018 (Tue)
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PDF icon Form E-65354.28 KB
Form E-652: Application for Life Care Provider Permit 08/07/2018 (Thu)
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PDF icon Life Care Provider Permit Application E-652.pdf673.06 KB
Form E-651: Checklist for Application for Life Care Provider Permit 02/06/2018 (Tue)
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PDF icon AdmLifeCareE651.pdf52.06 KB
Form E-503-TPA: Affidavit of Lost Certificate of Registration 03/12/2018 (Tue)
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PDF icon Form E-503-TPA Affidavit of Lost Certificate of Registration.pdf983.69 KB
Form E-200: TPA Registration Application Checklist 02/12/2018 (Tue)
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PDF icon TPA Form E-200_20160721.pdf927.57 KB
Form E-178: Certificate of Disclosure 10/07/2018 (Tue)
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PDF icon E178_20180703.pdf726.07 KB
Form E-115: Life and Health (Third-party) Administrator Information Update 02/12/2018 (Tue)
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PDF icon TPA Form E-1151.46 MB
Form E-111: Renewal Application for Life and Health Administrator Registration 02/12/2018 (Tue)
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PDF icon Form E-111 TPA Renewal Application.pdf1.41 MB
Form E-100: Application for Life and Health Administrator Registration 08/08/2019 (Mon)
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PDF icon Form E-100 TPA New Application 20190809.pdf1.72 MB
Form E-100-B: Life and Health Administrator Biographical List 02/12/2018 (Tue)
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PDF icon Form E-100-B TPA Biographical List.pdf767.11 KB
Form E-100-A: Life and Health Administrator Registration Addendum 02/12/2018 (Tue)
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PDF icon Form E-100-A TPA New Application Addendum.pdf762.14 KB
Form CU 1621: Credit Property/Credit Unemployment Certification of Rates 02/04/2019 (Mon)
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PDF icon CU 1621 Certification Form.pdf694.38 KB
Form C-TPC: Third-party Consent 08/04/2018 (Sun)
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PDF icon Form C-TPC137.9 KB
Form C-RFI 03/07/2018 (Mon)
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PDF icon form_c-rfi.pdf850.66 KB
Form 1024B: Insurer Rate Service Organization Calculation of Company Loss Cost Multiplier 08/11/2014 (Fri)
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Microsoft Office document icon CALCULATION_OF_COMPANY_LOSS_COST_MULTIPLIER_1024B.DOC26 KB
Form 1024B: Calculation of Company Loss Cost Multiplier 08/11/2014 (Fri)
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PDF icon CALCULATION_OF_COMPANY_LOSS_COST_MULTIPLIER_1024B_(Fillable).pdf70.68 KB
Form 1024A: Insurer Rate Service Organization Reference Filing Adoption Form 08/11/2014 (Fri)
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PDF icon REFERENCE_FILING_ADOPTION_FORM_1024A_(Fillable).pdf30.92 KB
Foreign Insurers 10/02/2019 (Thu)
FOREIGN INSURER: Unaffiliated Credit Life & Disability Reinsurer 03/01/2019 (Fri)
FOREIGN INSURER: Title Insurer 03/01/2019 (Fri)
FOREIGN INSURER: Service Corporation (HMDO) 03/01/2019 (Fri)
FOREIGN INSURER: Risk Retention Group 03/01/2019 (Fri)
FOREIGN INSURER: Property/Casualty Insurer 03/01/2019 (Fri)
FOREIGN INSURER: Prepaid Legal Insurer 03/01/2019 (Fri)
FOREIGN INSURER: Mortgage Guaranty Insurer 03/01/2019 (Fri)
FOREIGN INSURER: Life/Disability/Health Insurer 03/01/2019 (Fri)
FOREIGN INSURER: HMDO Service Corporation 03/01/2019 (Fri)

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Warning - Phishing Scam

We are aware of a phishing scam targeting insurance professionals claiming that the National Association of Insurance Commissioners received a complaint that the professional submitted a falsified claim. This fraudulent email displays the NAIC and CIPR logos, can originate from what appears to be an naic.org or gmail.com email account, and instructs the recipient to click on a link to download the complaint notification.

Certain antivirus products will detect this as a malicious email.  If you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or [email protected].