Application for Certificate of Authority
Gift Annuity
Chapter 615, Wis. Stat.

To view any of the listed statutes, see the Wisconsin Revisor of Statutes Web site.

The following are documents which must be completed and returned with the application for a license as a charitable gift annuity:

  1. Application fee of $100.00 and $100.00 fee for issuing Certificate of Authority payable to Commissioner of Insurance.
  2. Certification that the organization has been in active operation for at least 10 years.
  3. A copy of the original certification that the organization has qualified as an exempt organization under the Internal Revenue Code, 26 U.S.C., subsection 501 (c) (3).
  4. Corporate documents:
    1. Certificate of Incorporation
    2. Articles of Incorporation
    3. Bylaws or Rules and Regulations
  5. Names, addresses, and official capacities of officers or directors.
  6. Copies of proposed forms of agreements with annuitants.
  7. A copy of the latest annual return (IRS Form 990) filed with the Internal Revenue Service (IRS). (If not required by the IRS, a statement to that effect from the IRS should be included.) If IRS Form 990 is not required, a current balance sheet (not over 12 months old from the date of filing) must be submitted. If the balance sheet is unaudited, it must be certified to by at least two officers of the organization.
  8. A statement that the corporation agrees to comply with the following to the extent that the outstanding annuities are not reinsured.
    1. That the required reserves and surplus shall be maintained as a segregated account in accordance with ss. 611.24 (3) (b) and (f), Wis. Stat.;
    2. That the assets of the segregated account shall be invested in accordance with ch. 881, Wis. Stat.;
    3. That the assets of the segregated account are not liable for any debts of the licensee other than those incurred under ch. 615, Wis. Stat.;
    4. That the general assets of the licensee are liable on annuities to the extent that the segregated fund is inadequate;
    5. That the assets of the segregated account shall at least equal in amount the sum of the reserves on its outstanding annuities plus a surplus of 10% of the reserves or $100,000, whichever is greater;
    6. That the corporation shall submit annually a calendar year statement from a qualified actuary certifying that the calculations used produce reserves which are in the aggregate at least as great as those reserves calculated according to the minimum standards set forth in s. 623.06, Wis. Stat.; and
    7. That the corporation shall submit annually by March 1 of each year an annual statement on nationwide basis for the current calendar year plus a detailed listing of the assets held as reserves in the segregated accounts.
  9. A statement that the corporation agrees to submit to the Commissioner to the extent of reinsurance of the annuities by an insurer authorized to do business in Wisconsin with direct liability of the reinsurer to the annuitants, proof adequate to satisfy the Commissioner as to the extent and validity of the reinsurance of the annuities.
  10. Application for Certificate of Authority, Gift Annuity, forms (OCI 21-003), below.

Please note there is also an additional $100 statutory fee for issuing the initial Certificate of Authority as required by s. 601.31 (1) (b), Wis. Stat. This is in addition to the $100 application fee submitted with this filing.

If you have any questions, please contact:

Kristin Forsberg
Licensing Specialist
Bureau of Financial Analysis and Examinations
(608) 266-9896
kristin.forsberg@wisconsin.gov


Application Forms (OCI 21-003)

The application forms are available to be downloaded below. Note, however, that you will need an Adobe Acrobat Reader to view or print the application forms, which you can download at no cost from Adobe .

Application Forms (opens in new window)


Wisconsin Insurance Laws and Regulations


A Designation of Registered Agent for Service of Process (OCI 12-014) form is available to be downloaded below. Note, however, that you will need an Adobe Acrobat Reader to view or print the application, which you can download at no cost from Adobe .

Designation of Registered Agent for Service of Process (opens in new window)
Fill and Print Version (opens in new window)


NAIC Company Code Application—For Wisconsin-Domiciled Gift Annuity Corporations Only

A link to the NAIC Company Code Application form is provided below for your convenience. Note, however, that you will need an Adobe Acrobat Reader to view or print the application form, which you can download at no cost from Adobe . Gift annuity corporations need not file financial data with the NAIC, but are required to obtain a NAIC Company Code. This assists with the collection of demographic statistics by state and federal authorities. Once the NAIC Company Code is issued, it remains in force for the entire existence of the Gift Annuity Corporation. Wisconsin cannot coordinate issuance of a NAIC Company Code to a Gift Annuity Corporation that is incorporated in a state other than Wisconsin.

NAIC Company Code Application (opens in new window)


Please direct questions to: ocifinancial@wisconsin.gov (please include your name, phone number, and e-mail address).