Last Updated: August 16, 2017
Application for Admission - Motor Club Services
Chapter 616, Wis. Stat.
To view any of the listed statutes, see the
Wisconsin Revisor of Statutes Web site.
Regulation of motor clubs in Wisconsin is subject to the jurisdiction of this office. The following are documents which must be completed and returned with the application for license:
- Application for motor club services.
- Declaration of liability as surety.
- Form of surety bond.
Also, one copy of each of the following should be filed with the application for a license:
- Copy of charter or articles of incorporation (certified by corporation secretary).
- Copy of the bylaws (certified by the corporation secretary).
- Certificate of compliance.
- Certificate of deposit from home state, if deposit is maintained.
- Copy of the most current financial statement.
- Copy of an independent audit report, if any.
- Copy of all policy forms, applications and advertising literature to be used.
- Biographical sketches - Form A (copy attached).
- Application fee of $400 payable to Commissioner of Insurance.
With reference to Item 2 above, the enclosed form is the one prescribed by the Office of the Commissioner of Insurance. This form may be executed and filed with the Commissioner in lieu of the required $25,000 deposit in cash or securities as otherwise required under s. 616.72, Wis. Stat.
In regards to Item 10 above, in order to establish if the motor club's forms comply with Wisconsin insurance laws, specifically s. 616.71, Wis. Stat., all policy forms, applications and advertising material the motor club company intends to use in Wisconsin are to be submitted for review. Once the motor club company's license is granted the company is required to file their forms in accordance with s. 631.20, Wis. Stat. To facilitate your application request we included our forms submission procedures. Forms must be filed prior to being used in Wisconsin. Forms include the following:
- Service contracts or membership handbooks.
- Membership application.
- Other forms which may be issued to members.
If you should have any questions concerning the Application, please contact Kristin Forsberg at (608) 266-9896 or
firstname.lastname@example.org. If you should have any questions concerning the policy forms, advertising material, applications or their contents, please contact Katherine Otis at (608) 266-0095 or
email@example.com. If you should have questions about the form submission procedures, please contact Shasta Hoffhein at (608) 264-8117 or
The initial/renewal forms are available to be downloaded below.
Initial Application Packet Forms
Annual Renewal Forms
Motor Club—Policy Forms Submission Procedures
Note: The following address is a link to the administrative code:
To link to chapters in the administrative code, add insxxx.pdf to the end of the address. xxx represents the chapter number in three digits (003 for chapter 3).
Section Ins 6.05, Wis. Adm. Code, sets forth the requirements for submitting forms for our Office's approval. To take full advantage of our automated policy form review and tracking system, we need submissions that follow a standard procedure. Therefore, we must strictly enforce the rule. Submissions will be disapproved if they do not contain the items required in (4) of the rule. These include: Insurance Policy Form Transmittal (OCI 26-015) in duplicate (see link below), Certificate of Compliance (see Appendix A of s. Ins 6.05, Wis. Adm. Code), Certificate of Readability (if required), cover letter in duplicate, one copy of each form, and a stamped self-addressed return envelope.
A properly completed Insurance Policy Form Transmittal (OCI 26-015) is required by s. Ins 6.05 (4) (a) 1, Wis. Adm. Code. This form is to be submitted in duplicate FOR EACH COMPANY filing.
The instructions and forms for filing 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
NAIC Company Code Application—For Wisconsin-Domiciled Motor Clubs Only Only
A link to the NAIC Company Code Application form is provided below for your convenience. Motor Clubs 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 Motor Club. Wisconsin cannot coordinate issuance of a NAIC Company Code to a Motor Club that is incorporated in a state other than Wisconsin.
NAIC Company Code Application
Wisconsin Insurance Laws and Regulations