Registered and Other Entities

Below you will find a listing of every state-specific 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 the North Dakota Insurance Department website.

Renewal Affidavit for Nonadmitted Companies

The Renewal Affidavit For Nonadmitted Companies must be submitted using the North Dakota Insurance Department's enhanced Online Renewal System. A completed copy of the renewal statement must be included and postmarked by March 1 to avoid penalties.

Forms

Purchasing Group

Application for Registration as a Purchasing Group (SFN 53914)

Registration of Appointment of Agent for Service of Process (SFN 53916)

 

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)

Certification as an Insurer of Automobile Warranty Contracts (SFN 54357)

 

Accredited Reinsurer

Certificate of Assuming Insurer (AR-1) (SFN 53913)

 

Trusteed Reinsurer

Certificate of Assuming Insurer (AR-1) (SFN 53913)

 

Surplus Lines Insurer

Agent for Service of Process (SFN 8330)

Affidavit (SFN 4795)

Data Processing Questionnaire (SFN 4792)

 

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.