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The following items must be submitted with the application in order to obtain a renewal of your Certificate of Registration.
Please number each item in the upper right-hand corner to correspond with its number in this Schedule of Requirements.
Items 1-6 must be completed for a Reinsurance Broker license.
Items 1-11 must be completed for a Reinsurance Manager license.
1. Filing Fee in the amount of $100.00
2. Written contract accompanied by the reinsurer's Board of Directors Resolution approving the contract. Contract provisions for Reinsurance Broker must be in compliance with IC 27-6-9-18; Reinsurance Manager must be in compliance with IC 27-6-9-21. Contract checklist must accompany contract, indicating where Indiana code citations can be found within highlighted contract (Not required of renewals, unless changes have been made) Broker Contract Checklist, Manager Contract Checklist
3. Copy of organizational chart.
4. Non-resident broker or alien manager must submit a power of attorney appointing the Commissioner for service of process. (Initial application only)
5. Alien manager or broker must provide name and address of Indiana appointed agent. (Not required of renewals, unless changes have been made)
6. Proof of licensure as an Indiana producer.
7. Current list of officers and directors.
8. Statement of financial condition prepared by an independent Certified Accountant. This statement may be in the form of a compilation report, a report of review or audit report. RM - IC 27-6-9-23(b) & 760 IAC 1-51-6. If RM establishes loss reserves, actuarial opinion attesting to the adequacy of loss reserves incurred and outstanding on business produced by RM in accordance with IC 27-6-9-23.
9. Biographical affidavits on all authorized persons. (Not required of renewals, unless changes have been made)
10 Errors and Omission Policy in the amount of $ _________________. (see 760 IAC 1-51-5)
11. Fidelity Bond from an insurer in the amount of $ ___________________ . (see 760 IAC 1-51-4)
Send the completed application and information to:
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, IN 46204-2787
To change any business information for the above please use the Service Request Form.