Forms

• Annual Company Profile Questionnaire
  • HCAS - Insurance Company
  • HCAS - Other Entities
• Basket Clause
• Biographical Affidavit -Even though Indiana utilizes the NAIC Biographical Affidavit, please do not include any personal identification numbers that are requested (SS#, Gov't ID# or Foreign Student ID#).
• Certificate of Advertising
• Corporate Governance Template
• Grievance Procedures & Appeals Report
  • 2020 Reporting Form
• Fidelity Bond Compliance
• Foreign Investments and Other Structured Securities - Life
• Foreign Investments and Mortgage & Asset Backed Securities - PC
• Form E
• Form F
• Health Care Exhibit Supplement Waiver Instructions and Form
• ICHIA Health Exhibit Form
• ICHIA Supplement Filings Instructions
• Indiana Fee and Retaliatory Fee Statement
• Indiana Fee and Retaliatory Fee Statement - Farm Mutual Only
• Premium Tax (see below)

NAIC OPTins

IDOI encourages the companies to use the NAIC OPTins system to help facilitate the processing of quarterly estimated tax, annual premium tax and annual renewal fee filings. IDOI does request once a company starts using OPTins to make such filings, the company continues to do so for ease of record keeping and auditing purposes.  Utilizing  OPTins allows a company to schedule submission of filings prior to or on the due date.  A company will need to allow at least 3 weeks for setting up an account in the OPTins system.  To obtain detailed information and setting up an account visit http://www.optins.org/
 

• Life
  • • Annual Premium Tax Return - Life
    • Estimated Premium Tax Quarterly
    • Premium Tax Code
• P&C
  • • Annual Premium Tax Return - Property and Casualty
    • Estimated Premium Tax Quarterly
    • Premium Tax Code

• Registered Agent/Service of Process
• Statement of Condition
  • Life
  • P&C

• Statutory Security Deposit FAQs
  • Joint Custodial Agreement
  • Year-End Statutory Deposit Filing
  • Periodical Deposit Transactions
  • Form 22 & Affidavit