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 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. 620, 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.

If you have any questions, please contact Yvonne Sherry (608) 266-0091 or Jackie Karls (608) 266-9891.

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

Wisconsin Insurance Laws and Regulations

Designation of Registered Agent for Service of Process

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   Fill and Print Version

Please direct questions to: financial@oci.state.wi.us (please include your name, phone number, and e-mail address).