NAIC FORMS

Form

Description

Location

ACORD Forms

Free online forms

www.insureHub.com

Amendment Form, aka UCAA  Corporate Amendment Application 

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa_corp_amend.htm

Annual Statement Forms - Including  exhibits, schedules & supplements

Required for Annual Statement Filings

The forms are available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Application for listing in NAIC Directory of Resources to Assist Regulators of Troubled or Insolvent Insurance Companies

Directory provides a listing of resource consultants for state insurance regulators and others

Contact the Insolvency Attorney in the NAIC Legal Department

Application Form for  listing on Bank List

Securities Valuation Office (SVO) Form

isis.naic.org/help/html/isis_help_atf_bank_letter_of_credit.htm

Application Form - Lloyd's syndicate

International Insurers Department (IID) Form 

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

AR-1 Form: Certificate of Assuming Insurer

Form regarding Conflict of Interest required by some states

NAIC Model Credit for Reinsurance Model Regulation and Section 6 Appendixes and Exhibits, Exhibit B, Example Form AR-1 Certificate of Assuming Insurer, Financial Condition Examiners Handbook. Both are available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Asset-Backed & Residential Mortgage Backed Securities, aka Structured Security Questionnaire

Securities Valuation Office (SVO) Form

http://www.naic.org/svo.htm

ATF Bank Letter of Credit - See Letter of Credit, aka Approval or Confirmation Letter

ISIS filing of Bank List

isis.naic.org/help/html/isis_help_atf_bank_letter_of_credit.htm

Authorization for Disclosure of Financial Records 

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Automated Valuation Service (AVS) Subscription Form

Full access customers can update their AVS contact and year-end information

isis.naic.org/help/html/isis_help_avs_yearend_contact.htm

Biographical Affidavit

Blanks Agenda Item Submission Form

http://www.naic.org/documents/committees_e_app_blanks_blanksagenda_formdoc.doc

Bond Lease Based CTL Application

Securities Valuation Office (SVO) Form.

http://www.naic.org/svo.htm

Business Plan Form

International Insurers Department (IID) Form

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

Ceded Reinsurance Contract Review

Reinsurance regulation

Section 6 Appendixes and Exhibits, Exhibit D General Reinsurance
Checklist, Financial Condition Examiners Handbook. Available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Certificate of Assuming Insurer, aka Form AR-1

Reinsurance regulation

NAIC Model 786, Credit for Reinsurance Model Regulation and Exhibit B, Part 4, Reinsurance: Financial Examiners Handbook  Both are available from the NAIC Insurance Products and Services Division http://www.naic.org/store_home.htm

Certificate of Compliance Form

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Certificate of Deposit Form

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Certification of Loss Reserves, aka Loss Reserve Certification Form

International Insurers Department (IID) Form

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

Change of Address/Contact Notification Form

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Collateral Loan Form

Securities Valuation Office (SVO) Form

http://www.naic.org/svo.htm

Commission Agreement for Brokers & Agents

Uniform Application for Individual Non-Residential License Form and Uniform Application for Business Entity Non-Resident License Form. Includes a section for background information

http://www.nipr.com/non_resident_paper_licensing.htm

Company Code Application Form

Application for NAIC Company Code

http://www.naic.org/documents/industry_company_code_app.pdf

Complaint Record Format

Complaint Records

NAIC Model 884, Model Regulation for Complaint Records to be Maintained Pursuant to the NAIC Unfair Trade Practices Act. The model is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Corporate Amendment Application

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa_corp_amend.htm

Corporate Amendments Checklist

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Counter party Rating Report aka Form CRR-1

Securities Valuation Office (SVO) Form

http://www.naic.org/svo.htm

Credit Lease Based CTL Application

Securities Valuation Office (SVO) Form 

http://www.naic.org/svo.htm

Credit Tenant Loan Evaluation Form for Bond Lease Based CTL

Securities Valuation Office SVO Form

http://www.naic.org/svo.htm

Credit Tenant Loan Evaluation Form for Credit Lease Based CTL

Securities Valuation Office SVO Form

http://www.naic.org/svo.htm

Custodial Affidavits or
Custodian Agreements

Form A: For use by a custodian bank where securities entrusted to its care have not been redeposited elsewhere.
Form B: For use where a custodian bank maintains securities on deposit with The Depository Trust Company or like entity.
Form C: For use where ownership is evidenced by book entry at a Federal Reserve Bank.

NAIC Model 298, Model Regulation on the Use of Clearing Corporations and Federal Reserve Book-Entry System by Insurance Companies. The model is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Discount Factor Form

Securities Valuation Office (SVO). Not a form per se

Filer submits discount information to the SVO on company letterhead

Emerging Accounting Issues Working Group Agenda Submission Form B

Form used by insurer to clarify an accounting issue  by the Emerging Accounting Issues Working Group (Emerging)

http://www.naic.org/documents/committees_e_app_eaiwg_EAIWGAgendaProcess_a.doc

Expansion Application 

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa_expansion.htm

Expansion Checklist

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Expedited Filing Transmittal Document for Terrorism Risk Insurance Forms and Pricing

NAIC form to assist insurers in complying with the Terrorism Risk Insurance Act of 2002. Part of Model Bulletin

http://www.naic.org/documents/topics_TRIA_Extension_Model_Bulletin.pdf

Filing Instructions

International Insurers Department (IID) Form

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

Financial Database Participation Packet

Instructions and materials for Annual Statement electronic filings

http://www.naic.org/industry_financial_filing.htm

Financial Filing Format aka IID Financial Filing Format

International Insurers Department (IID) Form

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

Form A State Role Request Form 

Oracle User Administration. Request for IDs or Roles from the Form A Database

http://www.naic.org/members_tech_ua_formastrrform.htm

Form A Filing aka Statement Concerning the Acquisition of Control or or Merger with a Domestic Insurer

 Statement Concerning the Acquisition of Control or Merger with a Domestic Insurer

Form A  is part of NAIC Model 450: Insurance Holding Company System Model Regulation with Reporting Forms and Instructions.  The forms are intended to be used as guides only. To obtain a copy of blank forms, contact state insurance departments.  The Model is available from the NAIC Insurance Products and Services Division, www.naic.org/store_home.htm.

Form M-1 for Annual Report for Multiple Employer Welfare Arrangements (MEWAs)

MEWA" M-1 Form"—This is not an NAIC form. It is available from the Department of Labor.

Department of Labor: http://www.dol.gov/ebsa/pdf/2002M1Form.pdf

Fraud Reporting Form and instructions

aka Uniform Suspected Insurance Fraud Reporting Form 

http://www.naic.org/committees_d_antifraud.htm

General Reinsurance Checklist

Reinsurance regulation

Section 6 Appendixes and Exhibits, Exhibit C, General Reinsurance Checklist, Financial Condition Examiners Handbook. Available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Form A: "Statement Regarding the Acquisition of Control of or Merger with a Domestic Insurer".
Form B: "Insurance Holding Company System Annual Registration Statement".
Form C: "Summary of Registration Statement".
Form D: "Prior Notice of a Transaction".
Form E: "Pre-Acquisition Notification Form".

NAIC Model 450: Insurance Holding Company System Model Regulation with Reporng Forms and Instructions. .Note: .The forms  are  intended to be guides only. To obtain a copy of  blank forms,  contact state insurance departments. The model is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

IID Interrogatories for Lloyd's Syndicates

International Insurers Department (IID) Form

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

Information Systems Controls Questionnaire aka ISQ

Used by Financial Examiners

Financial Condition Examiners Handbook, Part 1 (General) Exhibit C. This publication is  available from from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Insurance Holding Company System Annual Registration Statement

Form B: "Insurance Holding Company System Model Regulation with Reporting Forms and Instructions"

NAIC Model 450: Insurance Holding Company System Model Regulation with Reporting Forms and Instructions. The model is available from  the NAIC Insurance Products and Services Division,  http://www.naic.org/store_home.htm

Insurehub website

Free online forms by name, by number & by state. Also Acord & Countrywide Forms

www.InsureHub.com

ISO Policywriting Support Forms

Insurance Services Office

http://www.iso.com/

Jurat - Standard IID Financial ReportingForm

International Insurers Department (IID) Form

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

Letter of Credit

Directions for an ISIS filing for the Bank List (banks which meet the credit standards of the SVO)

isis.naic.org/help/html/isis_help_atf_bank_letter_of_credit.htm

Uniform Letter of Credit Form

NAIC Model 795: Reinsurance: A Model Act for the Regulation of Reserves Ceded to Nonadmitted Reinsurers.  Appendix. The model is available from the NAIC Insurance Products and Services Division,  http://www.naic.org/store_home.htm

Letter of Credit Definition 

NAIC Model 280: Investments of Insurers Model Act, p 280-10. The model is available from  the NAIC Insurance Products and Services Division

http://www.naic.org/store_home.htm

Letter of Credit Form

Reinsurance regulation

Section 6 Appendixes and Exhibits, Exhibit A Example Let5ter of Credit Form, Financial Condition Examiners Handbook. Available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Life Insurance & Annuities Replacement Forms
Aka:NAIC Notice of Replacement Letter

Appendix A, B, & C Life Insurance and Annuities Replacement Model Regulation

NAIC Model 613: Life Insurance and Annuities Replacement Model Regulation. The model is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Lines of Insurance 

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Long Term Care Insurance Forms: Rescission Reporting Form,  Personal Worksheet ,Things You Should Know, Suitability Letter, Claims Denial Form & Replacement/ Lapse Reporting Form

Appendix A-G: Long Term Care Insurance Model Regulation

NAIC Model 641:Long Term Care Insurance Model Regulation is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Long Term Care Insurance Report Form 

For departmental use

NAIC Model 645: Proposed Circular Letter and Report Form for Gathering Information on LTC Policies /Long Term Care Insurance Report Form is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

For departmental use (other than Workers comp)

http://www.naic.org/loss_cost.htm

Loss Reserve Certification Form aka Certification of Loss Reserves

International Insurers Department (IID) Form.

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

Market Conduct Database

Forms to complete for Market Conduct Annual Statement

http://www.naic.org/industry_market_conduct_statement.htm

Matrix of State Requirements

Non-resident licensing requirements/Uniform Application for Individual Non-Resident License 

http://www.nipr.com/non_resident_paper_licensing.htm

Medical Malpractice Claim Report Form, aka NAIC Medical Professional Liability Insurance Uniform Claims Report

For departmental use

Page 6, NAIC Malpractice Claims, Final Compilation, 1975-1978. This publication is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Medicare Supplement Form for Reporting Medicare Supplement Policies 

Appendix B: Medicare Supplement Insurance Regulation 

NAIC Model 651: Medicare Supplement Insurance Regulation is available from  the NAIC Insurance Products and Services Division http://www.naic.org/store_home.htm

Medicare Supplement Refund Calculations Form

Appendix A: Medicare Supplement Insurance Regulation 

NAIC Model 651: Medicare Supplement Insurance Regulation is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Medicare Supplement Reporting Form  for the Calculation of Benchmark Ratio Since Inception for Individual Policies 

Appendix A: Medicare Supplement Insurance Regulation 

NAIC Model 651: Medicare Supplement Insurance Regulation is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Department of Labor: http://www.dol.gov/ebsa/pdf/2002M1Form.pdf

Mutual Fund Filing 

Securities Valuation Office (SVO) Form

isis.naic.org/help/html/isis_help_atf_mutual_fund.htm

NAIC Medical Professional Liability Insurance Uniform Claims Report

For departmental use

Page 6, NAIC Malpractice Claims, Final Compilation, 1975-1978. This publication is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

For departmental use 

Appendix A (A-18) Market Conduct Examiners Handbook. This publication is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

NAIC Uniform Continuing Education Reciprocity Project, aka NAIC CE Reciprocity (CER) Process

Part of Midwest Zone Continuing Education Reciprocity Plan. Part of Uniform Regulation thru Technology (URTT) Program

http://www.naic.org/urtt_cer.htm

NAIC Uniform  Review Standards Checklist

SERFF (System for Electronic Rate and Form Filing) Form

http://www.naic.org/industry_rates_forms_ursc.htm

Notice of Regulatory Activity (RIRS Form)

For submission of regulatory actions reported to the NAIC. Includes NAIC RIRS codes.

I-SITE (rirsform_2) (Regulators only)

Notice of Transfer and Response Card

Appendix A of Assumption Reinsurance Model Act re Transfer Policy

NAIC Model 803, Assumption Reinsurance Model Act, is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Office & Directors Form

Instructions for completing in Annual Supplement section of Annual Statement Instructions

The blanks do not contain an example. The form is usually available in company's vendor software. The form is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

P & I Multiple Issues

Securities Valuation Office (SVO). New versions accommodating amendment to the 5* 6* Rules.

http://www.naic.org/svo.htm

P & I Procedures

P & I Single Issue

Paper Based Filings - State Form

SERIFF Instructions for industry or state to create a paper transmittal form 

Plan of Operation for listing of alien non-admitted insurers aka IID Plan of Operation

International Insurers Department (IID) Form

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

Policyholder Disclosure Notice of Terrorism Insurance Coverage

NAIC form to assist insurers in complying with the Terrorism Insurance Act of 2002

http://www.naic.org/documents/topics_tria_disclose1.pdf

Power and Pipe Line Annual Review Summary

Securities Valuation Office (SVO) Form.

http://www.naic.org/svo.htm

Power of Attorney to Appoint/Certify Agents

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Pre-Acquisition Notification Form

Form E: "Insurance Holding Company System Model Regulation with Reporting Forms and Instructions".

NAIC Model 450, Insurance Holding Company System Model Regulation with Reporting Forms and Instructions. The model is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Primary Application Form 

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Primary Checklist

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Principal and Interest Certification Forms,
aka P&I Single and Multiple  Issues.

SVO. New versions to accommodate amendment to the 5* 6* Rules.

http://www.naic.org/svo.htm

Prior Notice of a Transaction

Form D: "Insurance Holding Company System Model Regulation with Reporting Forms and Instructions".

NAIC Model 450 Insurance Holding Company System Model Regulation with Reporting Forms and Instructions. The model is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Private Placement Memorandum, aka Guide 6 Form. See Valuation Information Memorandum (VIM)

Securities Valuation Office (SVO) Form

http://www.naic.org/svo.htm

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Project Information Memorandum

Securities Valuation Office (SVO) Form

http://www.naic.org/svo.htm

Purchasing Group Form-Notice & Registration Form,  Part A,  aka Uniform Application for Purchasing Group Form

Uniform Registration Form for Securities Acquisition Report (SAR)

Appendix E, Risk Retention & Purchasing Group Handbook, Handbook. The handbook  is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Purchasing Group Form-Appointment of Attorney to Accept Service & Designation, Part B

Uniform Registration Form for Securities Acquisition Report (SAR)

Appendix E, Risk Retention & Purchasing Group Handbook,  The handbook is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Quarterly Listing Application Form

International Insurers Department (IID) Form

http://www.naic.org/documents/Lloyds_Application.doc

Questionnaire (Primary & Expansion)

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Questionnaire (Corporate Amendments)

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

RTAS Application
Regulatory Treatment Analysis Service

To facilitate use of the Regulatory Treatment Analysis service

http://www.naic.org/documents/svo_rtas_app.pdf

Regulatory Treatment Analysis Service Application (RTAS)

To facilitate use of the Regulatory Treatment Analysis service

http://www.naic.org/documents/svo_rtas_app.pdf

Replacement of Life Insurance or Annuities Form, aka Life Insurance or Annuities Replacement

Appendix A, B, & C Life Insurance and Annuities Replacement Model Regulation

NAIC Model 613: Life Insurance and Annuities Replacement Model Regulation. The model is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Replication (Synthetic Asset) Transactions Forms

Securities Valuation Office (SVO) Forms

http://www.naic.org/svo.htm

Residential Mortgage Quality Matrix Model

Designed to provide filers with a tool for calculating residential mortgage pool quality scores pursuant to filing an application to the SVO

http://www.naic.org/svo.htm

Risk Retention Reporting Form

Uniform Registration Form for Securities Acquisition Report (SAR)

Appendix C, Risk Retention & Purchasing Group Handbook. The handbook is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Risk Retention Group -  Notice and Registration Form,  Part A 

Uniform Registration Form for Securities Acquisition Report (SAR)

Appendix D, Risk Retention & Purchasing Group Handbook.  The handbook is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Risk Retention Group Form  - Appointment of Attorney to Accept Service & Designation, Part B

Uniform Registration Form for Securities Acquisition Report (SAR).

Appendix D, Risk Retention & Purchasing Group Handbook. The handbook is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Risk Retention Purchasing Group - Notice and Registration Form. See Purchasing Group - Notice and Registration Forms

Uniform Registration Form for Securities Acquisition Report (SAR).

Appendix E,Risk Retention & Purchasing Group Handbook. The handbook is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Self Certification Form

SERFF (System for Electronic Rate and Form Filing) Form

http://www.naic.org/documents/industry_rates_self_cert_pilot.pdf

Security Acquisition Report (SAR)

Securities Valuation Office (SVO) Filing

A type of filing created on ISIS. An ATF (Authorization To File ) is created and submitted to the NAIC within 120 days of an insurance company’s acquisition of a security. The process for generating an SAR can be found under internet filings on www.naic.org/. You must have a login and password to create an ATF

Short Form Application For Written Consent to Engage in the Business of Insurance under the Provisions of the Violent Crime Control & Law Enforcement Act of 1984

Short form (.pdf)

Standard Certification Form

Used to verify the status of an agent who is seeking a non-resident licenser

NAIC Model 212: Standard Certification Form.  The model is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Standard Financial Filing Format, Jurat 

International Insurers Department (IID) 

http://www.naic.org/IID_docs/jurat.doc

Standard Form Trust Agreement for Alien Excess or Surplus Lines Insurers

International Insurers Department (IID) 

Standard Letter of Clearance 

Used to verify the status of an agent's license in his/her state of domicile when the agent is seeking to be licensed as a registered agent in another state

NAIC Model 213: Standard Letter of Clearance. The model is available from  the NAIC Insurance Products and Services Division,  http://www.naic.org/store_home.htm

Statement Regarding the Acquisition of Control of or Merger with a Domestic Insurer

Database allowing on-line entry of data from the Statement Concerning the Acquisition of Control or Merger with a Domestic Insurer.Also: Form A in Model 450: Insurance holding Company System Model Regulation with Reporting Forms & Instructions

To access Form A Role Request Form: http://www.naic.org/members_tech_ua_formastrrform.htm Also in NAIC Model 450: Insurance Holding Company Model Regulation  with Reporting Forms & Instructions. The model is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Statutory Accounting Principles Working Group Maintenance Agenda Submission Form A

Used by insurer to request clarification on an accounting issue by the Statutory Accounting Principles Working Group (SAPWG)

http://www.naic.org/documents/committees_e_app_eaiwg_EAIWGAgendaProcess_a.doc

Structured Security Questionnaire (Asset-Backed & Residential Mortgage Backed Securities)

Securities Valuation Office (SVO) Form

http://www.naic.org/svo.htm

Summary of Registration Statement

Form C: Model 450, Insurance Holding Company System Model Regulation with Reporting Forms & Instructions

NAIC Model 450: Insurance Holding Company System Model Regulation with Reporting Forms & Instructions. The model is available from the NAIC Insurance Products and Services Division,  http://www.naic.org/store_home.htm

Surplus Line Premium Tax Allocation Schedule – Criteria for Tax Allocation of Multi-State Risks

Appendix A: Model 872

NAIC Model 872: Allocation of Surplus Lines & Independently Procured Insurance Premium Tax on Multi-state Risk Model Regulation, http://www.naic.org/store_home.htm

SVO Compliance Certification

Securities Valuation Office (SVO) Form

Annual Statement General Instructions section

Tax Allocation Report

Appendix B: Model 872

NAIC Model 872: Allocation of Surplus Lines & Independently Procured Insurance Premium Tax on Multi-state Risk Model Regulation, http://www.naic.org/store_home.htm

Transmittal Documents

SERIFF Instructions for industry or state to create a paper transmittal form

http://www.naic.org/industry_rates_forms_trans_docs.htm

Treasury Stock Form aka Treasury Stock and Reciprocal Ownership Elimination Worksheet

Securities Valuation Office (SVO) Form 

http://www.naic.org/svo.htm

TRIA Schedule

Lloyd’s Syndicate Annual Filing

http://www.naic.org/committees_c_surplus_lines_iid_plan.htm

UCAA Proposal Form

To accompany proposals to modify UCAA documents

http://www.naic.org/industry_ucaa.htm

UCAA State Role Request Form 

Oracle User Administration. UCAA Form 

http://www.naic.org/members_tech_ua_ucaarrform.htm

UCAA State Specific Information

Additional authorizations other than Certificate of Authority

http://www.naic.org/industry_ucaa.htm

Uniform Application for Individual and Business Entity License/Registration Form

Uniform Application adopted by the Producer Licensing Working Group

http://www.naic.org/committees_d_producer_licensing.htm

Uniform Application for Business Entity License (a uniform non-resident application form)

Uniform Non-Resident Applications 

Uniform Application for Individual License (a non-resident application form)

Uniform Non-Resident Applications 

Uniform Appointment/Termination Form and Procedures

Uniform Application adopted by the Producer Licensing Working Group

http://www.naic.org/committees_d_producer_licensing.htm

Uniform Certificate of Authority (USCC) Application, Checklist & Forms

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Uniform Claim Forms - Health

 Descriptions & requirements.

NAIC Model 30, Standardized Health Claim Form Model Regulation. The model is available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Uniform Consent to Service of Process (Expansion & Corporate Amendments only)

Uniform Certificate of Authority (UCAA) Filing Form

http://www.naic.org/industry_ucaa.htm

Uniform Producer and Business Entity Renewal/Continuation Application, aka Uniform Insurance License Renewal/Continuation Form

Uniform Application form adopted by the Producer Licensing Working Group

http://www.naic.org/committees_d_producer_licensing.htm

Uniform Producer and Business Entity Reinstatement Application

Uniform Application form adopted by the Producer Licensing Working Group

http://www.naic.org/committees_d_producer_licensing.htm

Uniform Producer Application for Individual Resident/Nonresident License

NIPR Uniform Resident Licensing and Licensing Reciprocity Form

http://www.nipr.com/resident_paper_licensing.htm

Uniform Product Coding Matrix

SERFF Instructions for industry or state to create a paper transmittal form

http://www.naic.org/documents/industry_rates_pc_matrix.pdf

Uniform Registration Form

see Risk Retention Group Form & Purchasing Group Form.

Risk Retention & Purchasing Group Handbook. The handbook is available from the NAIC Insurance Products and Services Division,  http://www.naic.org/store_home.htm

Uniform Request for Company Appointment/Cancellation Form 

Not an NAIC Form 

Contact State Department of Insurance 

Uniform TPA Application, aka Application for Third Party Administrator License/Registration

Uniform Application form adopted by the Producer Licensing Working Group

http://www.naic.org/committees_d_producer_licensing.htm and NAIC Proceedings, 3rd Quarter. September, 2001, Attachment One-B-1, Market Conduct & Consumer Affairs (D) Committee, p 196

Valuation Information Memorandum (VIM) For Securities not Rated by an SVO Recognized Rating Agency

Securities Valuation Office (SVO) Form.

http://www.naic.org/svo.htm

Verification of Coverage for Life Insurance Policies aka VOC form 

To be completed by Viatical Settlement Provider or Broker 

NAIC Model 698: Viatical Settlement Model Regulation, Appendix B. The model is  available from the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm

Viatical Settlement Provider/Broker Report. Includes Individual Mortality Report & Viatical Settlement Provider/Broker Certification Form  

To be completed by Viatical Settlement Provider or Broker

NAIC Model 698: Viatical Settlement Model Regulation,  Appendix C. The model is available from  the NAIC Insurance Products and Services Division, http://www.naic.org/store_home.htm