This
site provides information on the licensing of insurance companies
who wish to operate in Alaska.
Click here for information on producer licensing
for agents or brokers as individuals or firms.
Click here for information on Surplus Lines Insurer application.
Certificate of Authority Forms - Application and Amendment For
Insurance Companies that write Life, Annuity, Health, Property,
Casualty, Surety, Marine, Mortgage Guaranty, Title, Fraternal (AS
21.09)
The Alaska Division of Insurance
is only accepting the Uniform Certificate of Authority Application.
The form and instructions are at: www.naic.org/ucaa/.
All application materials must
be kept current while the application is pending with the Division.
Annual and quarterly financial statements must be submitted in a
timely manner while the application is pending.
Alaska Statute AS 21.09.110(b)
specifies that policy forms and rates that require approval prior
to use are not to be submitted with the application for certificate
of authority. As permitted by AS 21.39.040(j) and AS 21.42.120(g),
the rates and forms may be filed while the certificate of authority
application is pending. The rate or form filing must specify
that
the company's certificate of authority application is pending and
approved rates or forms will only become effective upon the issuance
of the certificate of authority. You may obtain a copy of the rate
and form filing requirements by referring to Alaska regulations
3 AAC 29, 3 AAC 31 and Bulletin 95-01 which can be found elsewhere
on the Division's web site.
Certificate
of Authority - Application
For Automobile Service Corporations (AS 21.59),
Health Maintenance Organization
(AS 21.86), Multiple Employer Welfare Arrangements (AS 21.85)
The following form must be submitted
with all required items for the appropriate certificate of authority.
All application materials must
be kept current while the application is pending with the Division.
Annual and quarterly financial statements must be submitted in a
timely manner while the application is pending.
Instructions with the form will
indicate any information or fees that must be submitted.
|
Form Number
|
Form Name
|
| 08-251
New |
Automobile
Service Corporation Application for Certificate of Authority |
|
08-251
(HMO)
|
Application for Health
Maintenance Organization Certificate of Authority
|
| 08-303
(MEWA) |
Application
for Multiple Employer Welfare Arrangement Certificate of Authority |
The following forms must also
be submitted with the application forms mentioned above.
|
Form Number
|
Form Name
|
|
08-252
|
Retaliatory Form (submit
with any retaliatory fee, deposits or other requirements of
the domiciliary state for an Alaska insurer).
|
|
08-253
|
Appointment
of The Director of Insurance or Their Successor as Attorney
for Service of Process
in Alaska
|
|
08-254
|
Designation of Person
to Receive Service of Process
|
|
08-280
|
Designation of Persons
to Contact
|
Certificate of Authority - Amendments One
of the following forms is required for any amendments to the Certificate
of Authority
- change of company name,
- change of lines of insurance,
- redomestication.
Instructions with the form will
indicate any information or fees that must be submitted.
|
Form Number
|
Form Name
|
|
08-251
|
Application for Certificate
of Authority
|
|
08-251
(HMO)
|
Application for Health
Maintenance Organization Certificate of Authority
|
Each company must complete and
submit the following form with its amendment application:
|
Form Number
|
Form Name
|
|
08-280
|
Designation of Persons
to Contact
|
Company must submit the following
form and meet all the requirements before surrender can be completed.
|
Form Number
|
Form Name
|
|
08-290 (PDF)
08-290 (MWord)
|
Voluntary Surrender of
Certificate of Authority - Please print on your company letterhead
|
Other Company Applications
Instructions with the form will indicate
any information or fees that must be submitted.
|
Form Number
|
Form Name
|
| 08-255 |
Application
for Certificate of Authority for a Joint Title Plant |
|
08-277G
08-238
|
Application for Accreditation
of Reinsurer
Certificate of Assuming
Insurer
|
|
08-1251
|
Risk Retention Group Registration
Form
|
Submission of Application for a Joint Title Plant, Accreditation of Reinsurer or Risk Retention Group Registration must be submitted with the following form.
|
Form Number
|
Form Name
|
|
08-254
|
Designation of Person
to Receive Service of Process
|
Please contact the following
if you have any questions:
| Applications |
Amendments |
Financial Examination
Section
Anchorage:
(907) 269-7900 |
Financial Reports & Audits Section
Juneau:
(907) 465-2515 |
|
or
send email to: insurance@alaska.gov
|
|
