Application for Licensure/Registration
Property Service Contract Provider/Administrator
Chapter 616, Wis. Stat.
The following are documents which must be completed and returned with the Application for Licensure as a Provider of Property Service Contracts or the Application for Registration as a Service Contract Administrator. Any questions about the application should be directed to Mr. Karl Albert (608-264-6236) or Ms. Kristin Forsberg (608-266-9896).
Please note that Service Contract Administrators as defined in s. 616.54 (1), Wis. Stat., must register as an Administrator.
No application will be considered completed until all items on the application form have been completed and all required forms have been completed, filed, and approved.
The application packet 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 .
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 .
Property Service Contract Policy Form Submission Instructions (for Service Contract Providers - Not Applicable to those registered as Service Contract Administrators only)
Service contract forms may be submitted in the System for Electronic Rate and Form Filing (SERFF) prior to receiving a certificate of authority. The instructions and forms for filing the service contracts for approval are available through SERFF. Further information about SERFF is available at http://www.serff.com.
NAIC Company Code Application - For Domestic Service Contract Providers Only (Not Applicable for Service Contract Administrators)
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 . Service Contract Providers 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 Service Contract Provider. Wisconsin cannot coordinate issuance of a NAIC Company Code to a Service Contract Provider that is incorporated in a state other than Wisconsin.
Please direct questions to: email@example.com (please include your name, phone number, and e-mail address).