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North Dakota Insurance Department
Adam Hamm, Commissioner
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Hard copy policy, form and rate filings

Required transmittal forms

The North Dakota Insurance Department, in Bulletin 98-1 introduced Policy, Form, and Rate Filing Transmittal form-ND1000 (SFN 51679). Per Bulletin 98-1 this form is required to be used when filing a hard copy policy, form, or rate filing.

Effective Nov. 24, 2003, the Department will accept either the National Association of Insurance Commissioner's (NAIC) new Uniform Filing Transmittal Form or Policy, Form and Rate Filing Transmittal form-ND1000 (SFN 51679). It will not be necessary to submit both.

NAIC forms
  • Property & Casualty Transmittal Document PC TD-1 is designed for property and casualty submissions.
  • Life, Accident & Health, Annuity, Credit Transmittal Document (Revised 11/21/2002) is designed for life, health, annuity and credit submissions.

For P/C Loss Cost filings: In addition to Policy, Form, and Rate Filing Transmittal form-ND1000 (SFN 51679), Prospective Loss Costs Reference Filing-NDPC300 (SFN 51681) is required.

For Crop Hail Loss Cost filings: In addition to Policy, Form, and Rate Filing Transmittal form-ND1000 (SFN 51679), Crop Insurance Rate Filing - NDPC200 (SFN 51682) is required.

For Consent to Rate filings: Use Consent to Rate Application-NDPC400 (SFN 51683). A Policy, Form, and Rate Filing Transmittal form-ND1000 (SFN 51679) is not required for this type of filing.

SERFF electronic filing

For SERFF filings requiring a filing fee:

If electronic funds transfer (EFT) is not used, then use SERFF Retaliatory Filing Fee-ND2000 (SFN 51680) when submitting the filing fee (check) through the mail.

For additional information, contact:

North Dakota Insurance Department
insurance@nd.gov
600 E. Boulevard Ave.
Bismarck, ND 58505-0320

701.328.2440
701.328.4880 fax
800.247.0560 toll free
800.366.6888 TTY line



Consent to Rate Application - NDPC400 SFN 51683
Crop Insurance Rate Filing SFN 51682
Fillable
Crop Insurance Rate Filing SFN 51682
Printable
NAIC Uniform Filing Transmittal Forms
Policy, Form and Rate Filing Transmittal-ND1000 SFN 51679
Prospective Loss Costs Reference Filing - NDPC300 - SFN 51681
SERFF Retaliatory Filing Fee - ND2000 - SFN 51680


Crop Insurance Rate Filing - NDPC200 (Excel)
ndpc200fillable.xls


North Dakota Insurance Department
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
Phone 701.328.2440
Toll free 800.247.0560
Fax 701.328.4880

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