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| Home : Companies : Company reporting forms : Registered and other entities |
Registered and other entities
Below you will find a listing of every form that applies to a registered entity. The annual filing requirements for each type of registered entity are explained under the company licensing section of this website.
Purchasing group
Application for Registration as a Purchasing Group (SFN 53914)
Registration of Appointment of Agent for Service of Process (SFN 53916)
Renewal Affidavit for Non-admitted Companies (SFN 53446)
Risk retention group not chartered in North Dakota
Application for Registration as a Risk Retention Group (Foreign) (SFN 53915)
Registration of Appointment of Agent for Service of Process (SFN 53916)
Renewal Affidavit for Non-admitted Companies (SFN 53446)
Certification as an Insurer of Automobile Warranty Contracts (SFN 54357)
Accredited reinsurer
Certificate of Assuming Insurer AR-1 (SFN 53913)
Renewal Affidavit for Non-admitted Companies (SFN 53446)
Trusteed reinsurer
Certificate of Assuming Insurer AR-1 (SFN 53913)
Renewal Affidavit for Non-admitted Companies (SFN 53446)
Surplus lines insurer
Agent for Service of Process (SFN 8330)
Affidavit (SFN 4795)
Data Processing Questionnaire (SFN 4792)
Renewal Affidavit for Non-admitted Companies (SFN 53446)
Reinsurance intermediary
Application for Individual Reinsurance Intermediary License (SFN 18556)
Application for Reinsurance Intermediary License - Corporation or Partnership (SFN 18739)
Agent for Service of Process (SFN 8330)
Premium finance company
Premium Finance Application (SFN 16825)
Premium Finance Company Balance Sheet (SFN 16836)
Annual Statement for an Insurance Premium Finance Company (SFN 16824)
Charitable gift annuities corporation
Application for Certification of Exemption to Issue Gift Annuities (SFN 17914)
Agent of Process - Attachment A (SFN 17912)
Segregated Account/Contents of Contract - Attachment B (SFN 17913)
Utilization review agent
Utilization Review Agent Certification (SFN 18378)
Utilization Review Filing Report (SFN 18332)
Please review the requirements for your entity under the company licensing section of this website.
If you have questions, or cannot find a form that you need, please contact:
Yvonne Keniston
ytkeniston@nd.gov
North Dakota Insurance Department
State Capitol, fifth floor
Dept. 401
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
701.328.2440
701.328.4880 fax
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