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All items must be submitted to complete the application. All materials must be sent postal mail, emailed or faxed information will not be accepted.
1. Completed Non-Resident TPA application. Each application question in each Section must be answered completely. Each "Yes" response must have supporting documentation attached.
2. Application fee of $50. (Checks made payable to IDOI)
3. Audited Financial Statement prepared by an independent certified public accountant for the two most recent fiscal years (if the applicant has been in business for less than two years, submit financial reports that have been prepared in accordance with GAAP and certified by an officer of the applicant.)
4. A current Letter of Good Standing from one of the states Department of Insurances' listed below on state letterhead. A copy of a license, NIPR print-out, or letter from Secretary of State is not acceptable.
|Delaware||Michigan||New Jersey||Oregon||West Virginia|
|Florida||Missouri||North Carolina||Rhode Island|
|Georgia||Mississippi||North Dakota||South Carolina|
The completed application, check and information should be sent to the following:
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787
*Note- All materials must be sent postal mail, faxed or emailed items will not be accepted*
After a complete filing has been approved, the Department will issue a paper license. The license will be mailed to the mailing address on the application.
NOTE: Any TPA licensed before June 1st must renew their license before August 31st of the same year.