Company Licensing
Company Licensing links …
Company Licensing
Uniform Certification of Authority Application
Company Licensing
- Corporate Amendment Requirements for Foreign Insurance Companies (pdf)
- Retaliatory Statement (pdf)
- System for Electronic Rate and Form Filings (SERFF)
- Uniform Certificate of Authority Application – NAIC Forms
- Uniform Certificate of Authority Application – Kansas Forms
Risk Purchasing Group
- Registration Packet (pdf)
- Change Form (pdf)
Risk Retention Group
- Risk Retention Group Application (pdf)
- Consent to Service of Process Form (pdf, external link)
Mailing/Contact:
Heather Droge
Kansas Insurance Department
1300 SW Arrowhead Road
Topeka, KS 66604 – 4073
Phone: (785) 296-7839
Fax: (785) 291-3673
Email: kid.commissioner@ks.gov
Uniform Certificate of Authority Application
Kansas State Specific Forms
Please do not complete any of the forms listed below at the time of application. If your “Uniform Certificate of Authority Application” for a Kansas Certificate of Authority is approved, you will be contacted and requested to complete some of these forms depending upon the lines of business your company has applied to underwrite in Kansas.
For additional information contact Patrick Mulvihill by phone at 785-296-5350, or email at Patrick.Mulvihill@ks.gov.
All documents are in PDF format unless otherwise indicated.
| LINE OF BUSINESS | FORMS TO BE COMPLETED |
|---|---|
| Fire | Form3, Form18, Form19 |
| Windstorm & Hail | Form18 |
| Extended Coverage | Form18 |
| Add’l Perils on Growing Crops | Form18 |
| Hail on Growing Crops | Form18 |
| Optional Perils | Form18 |
| Sprinkler Leakage | Form18 |
| Business Interruption | Form18 |
| Earthquake | Form18 |
| Water Damage | Form18 |
| Aircraft Hull | Form18 |
| Ocean Marine | Form18 |
| Inland Marine | Form18 |
| Rain | None |
| Auto Physical Damage | Form23, Form3, Form22*, Form21*, Form7 |
| Flood | Form18 |
| Homeowners Policies | Form3 |
| Farmowners Policies | Form3 |
| Automobile Liability | Form23, Form3, Form22*, Form20*, Form21*, Form7, Form6 |
| General Liability | Form23, Form5, Form6 |
| Workers Compensation | Form23, Form5, Form6 |
| Fidelity, Surety & Forgery Bonds | Form23 |
| Glass | Form18 |
| Burglary, Theft & Robbery | Form23, Form3 |
| Boiler & Machinery | Form23, Form3 |
| Credit | Form23 |
| Title | None |
| Malpractice Liability | Form23, Form5, Form6 |
| Livestock Mortality | Form23, Form3 |
| Aircraft Liability | Form23 |
| Cargo Liability | Form23, Form18 |
* you must complete two (2) copies of this form