Application for Warranty Plans

​​​​​​​​​Last Updated: January 17, 2019​

Application for A Limited Certificate of Authority Warranty Plan
Chapter Ins 15, Wis. Adm. Code

Note: The following address is a link to the administrative code:​

The following are documents which must be completed and returned with the Application for Limited Certificate of Authority for a Warranty Plan. Any questions about the application should be directed to Mr. John Pollock (608-266-3325 or or Ms. Kristin Forsberg (608-266-9896 or

Also included is information detailing the procedures for submitting the warranty contracts for approval. All warranty contracts must be approved before the certificate of authority will be issued. Any questions about the policy form procedures should be directed to Ms. Karen Becker at (608) 267-9710​​.

Please note that Warranty Plan Administrators as defined in s. Ins 15.01 (4) (f), Wis. Adm. Code, must obtain a limited certificate of authority as a warranty plan.

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.​

Application Packet Forms

The application packet forms are available to be downloaded below.

Application Packet 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.

Designation of Registered Agent for Service of Process 
Fill and Print Version

Warranty Contract Submission Instructions and Forms

The instructions and forms for filing the warranty contracts for approval are available to be downloaded below, under the first two items under the heading "Policy Form Filing Instructions and Forms."

Policy Form Filing Instructions and Forms​


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