Wisconsin Office of the Commissioner of Insurance Forms


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Forms

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OCI will gradually be offering forms in a pdf format with fillable fields which can be filled in and then printed. The forms with this feature will have a link titled Fillable next to the form name (see Instructions for Fillable PDF Forms for use of these forms).

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Agent
Company: Financial | Policy Form and Rate Filings | Special Reporting Forms
Consumer
General


Application Forms
	OCI 11-041Atty Attorney Title Intermediary License App. (Resident)
	OCI 11-050 Business Entity Insurance License App. Fillable
	CE Waiver (external site)
	OCI 11-046 Individual Employee Benefit Plan Administrator License App.
	OCI 11-044 Managing General Agent License App. (Resident/Nonresident)
	OCI 11-041N Nonresident Agent License App. Fillable
	OCI 11-026 Prelicensing Exemption Form
	OCI 11-034 Reinsurance Intermediary Broker License App. (Resident/Nonresident)
	OCI 11-043 Reinsurance Intermediary Manager License App. (Resident/Nonresident)
	OCI 11-041R Resident Insurance Agent License Application Without Examination Fillable
	OCI 11-070 Surplus Lines License App. Fillable
	OCI 11-005 Temporary Insurance Agent License App.
	OCI 11-042 Viatical Settlement Broker License App.
	Crime Waiver Short Form Application for Written Consent to Engage in the Business of Insurance (external site) (National Association of Insurance Commissioners' Form)
	National Nonresident Application Information (external site)
Service Request Forms
	OCI 11-011 Notice of Termination
	OCI 11-001 Resident/Nonresident Agent Appointment
	OCI 11-074 Request for Letters of Certification/Clearance
Surplus Lines Tax Form
	OCI 27-015 Surplus Lines Tax Report Fillable
Pearson VUE (formerly Promissor) Candidate Handbook
	Candidate Handbook (external site)
Small Employer
	OCI 26-501 Small Employer Uniform Employee Application for Group Health Insurance
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Financial

Annual Statement Packets
	OCI 22-030 Fraternal Societies
	OCI 22-080 Gift Annuity Insurers Fillable
	OCI 22-060 Health Maintenance Organizations
	OCI 22-050 Hospital, Medical, Dental and Indemnity Corporations
	OCI 22-040 Life, Accident and Health Insurers
	OCI 22-049 Health Insurers--Life, Accident and Health Insurers
	OCI 22-065 Limited Health Service Organizations
	OCI 22-010 Property and Casualty Insurers (including Mortgage Guaranty Insurers)
	OCI 22-019 Health Insurers--Property and Casualty Insurers
	OCI 22-020 Title Companies
	OCI 27-002 Warranty Plans
	OCI 22-070 Town Mutual Insurers
OCI 26-003 Amendment to Articles of Organization, Town Mutual
Application for Licensure/Registration/Renewal
	OCI 21-007 Wisconsin Retaliatory Fees
Company Appointment Forms
	OCI 11-011 Notice of Termination
	OCI 11-001 Resident/Nonresident Agent Appointment
Independent Review Organizations
	OCI 32-001 Application for Certification
	OCI 32-003 Application for Recertification
	OCI 32-002 Annual Report Form
Premium Tax and Annual Fees
	OCI 27-013 Annual Taxes and Fees Payment Form
	OCI 27-013 Quarterly Tax Payment Form
Schedule of Taxes and Fees
	OCI 22-046 Nondomestic Life and A&H Insurers
	OCI 22-802 Nondomestic Life and A&H Insurers (Companies claiming investment credits pursuant to ss. 76.635, 76.636, 76.637, and 76.638, Wis. Stat.)
	OCI 22-045 Domestic Life Insurers
	OCI 22-801 Domestic Life Insurers (Companies claiming investment credits pursuant to ss. 76.635, 76.636, 76.637, and 76.638, Wis. Stat.)
	OCI 22-094 Domestic Mortgage Guaranty Insurers
	OCI 22-013 Nondomestic Property and Casualty
	OCI 22-800 Nondomestic Property and Casualty (Companies claiming investment credits pursuant to ss. 76.635, 76.636, 76.637, and 76.638, Wis. Stat.)
	OCI 22-012 Domestic Property and Casualty
Directly Placed Unauthorized Tax Report
	OCI 27-016 Directly Placed Unauthorized Tax Report Fillable
Quarterly Statement Forms
	OCI 22-310 Health Companies Compulsory and Security Surplus Calculation
	OCI 22-008 Property & Casualty Compulsory and Security Surplus Calculation
	OCI 22-009 Life Companies Compulsory and Security Surplus Calculation
	OCI 22-331 Fraternal Insurers Compulsory and Security Surplus Calculation
	OCI 22-061 HMO Insurer Compulsory & Security Surplus Calculation
	OCI 22-091 Mortgage Guaranty Insurers Report of Policyholders Position
	OCI 22-500 Schedule of Covered Expenses--Health Maintenance Organizations
	OCI 25-071 Town Mutual Quarterly Statement
Statutory Hold-Harmless Forms (Opt-Out/In)
	OCI 22-510 Election of Exemption (Opt-Out)
	OCI 22-530 Termination of Exemption (Termination of Opt-Out)
	OCI 22-520 Election to be Subject to Restrictions (Opt-In)
	OCI 22-540 Termination of Election to be Subject to Restrictions (Termination of Opt-In)
OCI 12-014 Designation of Registered Agent for Service of Process Fillable
Unauthorized Insurers
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Policy Form and Rate Filings

Interstate Insurance Product Regulation Commission The Interstate Insurance Compact (Compact) is an important modernization initiative that benefits state insurance regulators, consumers and the insurance industry. The Compact established a multi-state public entity, the Interstate Insurance Product Regulation Commission (IIPRC) which serves as an instrumentality of the Member States. The IIPRC serves as a central point of electronic filing for certain insurance products, including life insurance, annuities, disability income and long-term care insurance to develop uniform product standards, affording a high level of protection to purchasers of asset protection insurance products. We encourage insurance companies to submit filings through the Interstate Compact. Interstate Insurance Product Regulation Commission
Health Rate Filing
	Credit Life and Disability Insurance, Individual Accident and Health Insurance, Long-Term Care Insurance and/or Medicare Supplement Insurance Rate Filing
	NAIC Uniform Transmittal Document
Policy Form Filing Procedures and Forms
	Form Filing Procedures as of July 1, 2008
	NAIC Uniform Transmittal Documents
	OCI 26-042 Medicare Supplement Advertising Transmittal Form Word pdf
Policy Form Checklists
	Aircraft
	Automobile
	Contractual Liability Policies
	Group Annuity
	Group Health
	Homeowner's
	Individual Annuity
	Individual Health
	Individual Life
	Long-Term Care
	Long-Term Care Advertisements
	Medical Malpractice
	Medicare Cost
	Medicare Select & Select Cost-Sharing
	Medicare Supplement & Cost-Sharing
	Medicare Supplement Advertisements
	Motor Clubs
	Property and Casualty
	Warranty Contracts
Property and Casualty Rate/Rule Filing
	Property and Casualty Rate/Rule Filing Procedures
	OCI 26-020 Consent to Rate Form
	OCI 26-122 Reference Filing Adoption Form
	OCI 26-123 Summary of Supporting Information Form
	OCI 26-124 Expense Constant Supplement
	NAIC Uniform Transmittal Document
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Special Reporting Forms

	OCI 17-013 Auto Repair Program Survey Private Passenger Auto Insurance Word pdf Fillable pdf
	OCI 26-700 Cancellation and Rescission Reporting Form Fillable pdf
	OCI 26-055 Commercial Liability Insurance Report
	OCI 17-400 Group Health Insurance Reporting Form Word Fillable pdf
	OCI 22-307 Health Insurance Risk-Sharing Plan Assessment Form
	OCI 26-903 HMO Data Collection
	OCI 51-005 Insurance Complaint Form
	Market Conduct Annual Statement
	OCI 26-035, OCI 26-036, and OCI 26-037 Medical Malpractice Insurance Report (Not available at this time)
	OCI 26-053 and OCI 26-054 Product Liability Insurance Report
	OCI 23-010 Reservation of Corporate Name Fillable
	OCI 17-011 Survey on Health Insurance Coverage in Wisconsin Fillable
	Title Insurance Average Premium Report
	OCI 17-014 Volunteer Drivers Survey, Private Passenger Auto Insurance Word pdf Fillable pdf
Grievance Report
	Grievance Reporting Documents
Long-Term Care
	OCI 26-113 Issuer Certification Form
	OCI 26-114 Policyholder Long-Term Care Partnership Plan Status Form
	Long-Term Care Reporting Forms
Managed Care Plan Certifications
	OCI 26-109 Certification of Managed Care Plan Type
	OCI 26-110 Certification of Access Standards
	OCI 26-112 Certification of Preferred Provider Plan Same Service Provisions
Medicare Supplement
	Medicare Supplement Reporting Forms
Small Employer
	OCI 26-051 Small Employer Actuarial Certification (Not available at this time)
	OCI 26-048 Small Employer Rate Change Report (Not available at this time)
	OCI 26-500 Monthly New Business Group Health Insurance Rates for Small Employers
	OCI 26-501 Small Employer Uniform Employee Application for Group Health Insurance
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	OCI 51-005 Insurance Complaint Form
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	OCI 12-014 Designation of Registered Agent for Service of Process Fillable
	OCI 14-200 OCI Room 239 Use Agreement and Equipment Request
	OCI 14-026 Request for Copies Fillable
	OCI 16-001 Request for OCI Speaker
	OCI 14-002 Wisconsin Insurance Report Order Form Fillable
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Updated: February 8, 2010

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