Last updated: January 17, 2019
Application for Organizational Permit and Certificate of Incorporation for Domestic Insurers, Chapter 611, Wis. Stat.
To view any of the listed statutes, see the
Wisconsin Revisor of Statutes website.
The following documents and required information and material must be completed and returned with the application for incorporation and license:
In the letter of transmittal accompanying the application, please prepare a listing of the material furnished and information which was not filed and the reason for not filing. Please number all material and data filed to correspond with this instruction page.
The statutory application fee is $400 payable to the Commissioner of Insurance.
The Application for Lines and Classes of Business form.
The Authority for Commissioner to Make Inquiry form.
The Designation of Registered Agent form.
The names, and for the preceding 10 years, all addresses and all occupations of all incorporators and proposed directors and officers. Submit completed Biographical Form A for each incorporator, proposed director, and officer.
For all corporate incorporators, their articles and bylaws, a list of the names, addresses, and occupations of all directors and principal officers and, for the 3 most recent years, their annual financial statements and reports. Submit completed Biographical Form A for each director and principal officer of all corporate incorporators.
The proposed articles which shall be signed and acknowledged by or on behalf of each incorporator, and the proposed bylaws.
All agreements relating to the corporation to which any incorporator or proposed director or officer is a party.
The amount and source of the funds available for organization expenses and capitalization of the insurer and the proposed arrangements for reimbursement and compensation of incorporators or other persons.
The proposed compensation of directors and officers.
The plan for solicitation of applications for qualifying insurance policies and for the corporation’s securities.
The forms to be used for stock subscriptions, certificates for shares, applications for qualifying insurance policies, subscriptions for mutual bonds and contribution notes, and the forms for bonds and notes.
The proposed capital, or the proposed minimum permanent surplus and the proposed initial surplus.
The plan for conducting the insurance business including:
The geographical area in which business is intended to be done in the first 5 years
The types of insurance intended to be written in the first 5 years
The proposed marketing methods
A summary of the applicant’s reinsurance program on business ceded, with retentions, maximum risks, types of contracts such as pro rata, excess of loss, and any other information which may be material to this part of the applicant’s operation
A summary of the applicant’s reinsurance assumed program with retentions, maximum risks, types of business, types of contracts to be issued, and other factors which may be material to this part of the applicant’s operations
Brief summary of the applicant’s investment policy
To the extent requested by the commissioner, the proposed method for the establishment of premium rates
If part of a Holding Company System, a registration statement as provided in s. Ins 40.03, Wis. Adm. Code
A projection of the anticipated operating results of the corporation at the end of each of the first 5 years of operation, based on reasonable assumptions of loss experience, premiums and other income, operating expense and acquisition costs, including any assumptions used in preparing financial projections and a summary of feasibility studies or marketing surveys which support the financial projections.
The NAIC Company Code Application
If you have any questions, please contact:
Company Licensing Specialist
Bureau of Financial Analysis and Examinations
The application forms are available to be downloaded below.
Initial Capital and Surplus Requirements
Section 611.19, Wis. Stat.
Minimum Capital and Permanent Surplus
The Commissioner may, by rule, establish the minimum capital for a stock corporation or the minimum permanent surplus for a nonassessable mutual organized under this chapter. In the absence of such a rule, the minimum capital or minimum permanent surplus shall be $2,000,000 or such greater amount as the Commissioner specifies by order.
Initial Expendable Surplus
A corporation organized under this chapter shall have an initial expendable surplus, after payment of all organizational expenses, of at least 50% of the minimum capital or minimum permanent surplus specified under sub. 1. or such other percentage as the Commissioner specifies by order.
Amount of Stated Capital
Section 180.16, Wis. Stat., applies to stock corporations.
Surplus: An assessable mutual organized under this chapter need not have a permanent surplus if the assessment liability of its policyholders is unlimited. If assessments are limited to a specified amount or a specified multiple or annual advance premiums, the minimum permanent surplus shall be the amount that would be required under sub. 1. if the corporation were not assessable, reduced by an amount that reasonably reflects the value of the policyholders’ assessment liability in satisfying the financial needs of the corporation.
Initial Expendable Surplus: An assessable mutual organized under this chapter shall have an initial expendable surplus of at least $100,000 after payment of all organizational expenses.
Initial Applications; General: Except under pars d. and e., no certificate of authority shall be issued to an assessable mutual until it has at least 400 bona fide applications for insurance from not less than 400 separate applicants on separate risks located in this state in each of the classes of business upon which assessments may be separately levied. A full year’s premium shall be paid with each application and the aggregate premium shall be at least $50,000 for each such class. If at any time while the corporation is an assessable mutual, the business plan is amended to include an additional class of business on which assessments may be separately levied, identical requirements shall be applicable to each additional class.
Initial Applications; Worker’s Compensation: Five employers or more may join in the formation of an assessable mutual to write only worker’s compensation insurance if, instead of the requirements of par. (c), policies are simultaneously put into effect that cover at least 1,500 employes, counting no more than 300 for any employer. A full year’s premium shall be paid by each employer, aggregating at least $100,000.
Initial Surplus in Lieu of Initial Applications: In place of initial applications and premium payments for any class of business, the corporation may provide the minimum permanent surplus and initial expendable surplus that the Commissioner would require for a nonassessable mutual organization to do that class of business under like conditions. The class of business shall, nevertheless, be assessable until conversion under s. 611.77 (1), Wis. Stat.
Mutuals With Open Contracts
A mutual organized under this chapter need not have a permanent surplus if it issues only contracts the benefits of which may be reduced by action of the board if assets are not sufficient to provide the protection specified in the contracts. The terms and format of any such open contact provision must be approved by the Commissioner before the mutual is given a certificate of incorporation.
Any corporation under this chapter which promises in its policies to supply services in lieu of or in addition to indemnity, on a basis giving the insurer no option whether it will supply services or pay indemnity, shall maintain such contracts with providers that it can be reasonably expected that services will be provided as promised in its contracts.
Reduction of Minimum Surplus
The Commissioner may, by order, reduce the minimum amounts of surplus required under subs. 1. and 2. if in the Commissioner’s opinion, the extent and nature of providers’ contracts under sub. 6., financial guarantees and other support by financially sound private or public corporations, a pressing social need in a particular community for the formation of a mutual insurance corporation to provide needed insurance coverage, or other special circumstances, justify the proposed reduction in the required surplus. A person who will directly compete with the proposed insurer is aggrieved within the meaning of s. 601.62 (3) (a), Wis. Stat.
Regulation Applicable to Municipal Insurance Mutual
Section 611.23, Wis. Stat.
Municipal Insurance Mutuals Applicable Rules
On application by the organizers of a municipal insurance mutual under s. 611.11 (4), Wis. Stat., the Commissioner may, by order, after a hearing, relax any requirements of this chapter to facilitate the formation, financing, and governance of the mutual. In the same order, the Commissioner shall impose substitute requirements designed to implement the purposes of s. 611.02 (2), Wis. Stat., as elaborated in this chapter.
Except under sub. 3., the provisions of chs. 600 to 646, Wis. Stat., applying to other mutuals organized or operating under this chapter apply also to municipal insurance mutuals.
Chapters 604 to 607, 612 to 619, 626, and 646, Wis. Stat., do not apply to such mutuals. The Commissioner may, by order, after a hearing exempt such a mutual from any other provisions on a finding that they are unnecessary for the protection of the interests of the municipalities and their citizens.
Municipalities (Section 611.11 (4), Wis. Stat.)
Any number of municipalities or associations of municipalities or both may organize a municipal insurance mutual under s. 611.13, Wis. Stat., subject to s.611.23, Wis. Stat., to provide liability insurance and risk management services for its members.
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
NAIC Company Code Application
A link to the NAIC Company Code Application form is provided for your convenience.
NAIC Company Code Application
Please direct questions to:
firstname.lastname@example.org (please include your name, phone number, and email address).