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The following items must be submitted 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 1-10 must be completed for a Reinsurance Manager license.
1. Each application question must be completed in full. Attach a separate sheet of paper, properly signed, if additional space is needed.
2. Renewal fee of $100, check made payable to IDOI.
3. 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.
4. Copy of organizational chart.
5. Proof of licensure as an Indiana producer or reinsurance intermediary broker/manager in a state with substantially similar laws as Indiana.
6. Copy of contract(s), with completed Contract Checklist if new agreements have been entered into or amendments have been made since the last renewal. (Broker Checklist) (Manager Checklist) If no amendments have been made, please submit a signed statement stating contract previously filed is still in effect.
7. A current listing of all officers and directors, and biographical affidavits for each newly elected officer, director, or partner of the RI since last renewal, originally signed and notarized.
8. 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. Proof of renewal on fidelity bond and errors and omissions policy. Certificate of Insurance is not acceptable.
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.