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State of Connecticut
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Connecticut Insurance Department
Connecticut Insurance Department
Connecticut Insurance Department
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Insurer Forms and Applications
Find a list of downloadable and online forms for insurance companies.
Accredited Reinsurers
Procedures For Recognition
AR1 Form - Certificate of Assuming Insurer
Uniform Consent to Service of Process
Annual Financial Filing Requirements
Fraternal Societies
Health Insurers
Life, Accident and Health Insurers
Property and Casualty Insurers
Retention of Assets Statement
Title Companies
Bail Bonds
Bail Bonds Regulation
Captive Insurance
TAX RETURNS
Form 115NIN – Nonadmitted Insurance Premium Tax Return Form
Form 115RRG – Tax Return Form for Foreign Risk Retention Group
Tax Return Form 207C
APPLICATIONS
Certified Public Accountant
Biographical Affidavit
Actuary Loss Reserve Certification
Captive Insurance Company Manager
License Application Form
NAIC Risk Purchasing Group Part A and B Application Form
NAIC Uniform Risk Retention Group Notice and Registration Form
OTHER
Change in Registration for Risk Purchasing Groups
Corporate Governance Guidance
Sample Letter of Credit
Connecticut Data Security Forms
Cybersecurity Exception Certification
Connecticut Insurance Data Security Law Exception Certification Form
Cybersecurity Notification Form
Complete this form and email to
cid.mc@ct.gov
along with all required attachments.
Data Security Law Annual Certification
Connecticut Insurance Data Security Law Annual Certification Form
Consumer Report Card Surveys
Consumer Report Card Survey Part 1
Five worksheets in this excel workbook
Consumer Report Card Survey Part 2
Seven worksheets in this excel workbook
Consumer Report Card Survey Addendum
All networks
Network Adequacy Surveys
Dental
Medical
Vision
Additional Resources
HEALTHCARE
Family Health Statement for CSEHRP
Health and Welfare Fee Assessment Reporting Form: Childhood Immunization Vaccine Assessment
Health Care Centers
Public Health Fee Assessment Report
FRAUD
Insurance Fraud Report Online Portal
OTHER
CT Surety Liquidation Bond Loss Claims Form
Formulary Survey
Professional Employer Organization Annual Certification
Property & Casualty Forms and Checklists
Termination "For Cause" Notice
153 Market Street, 7th Floor
Hartford, CT 06103