The chart below identifies the Fingerprint and Biographical Affidavit requirements for each Domestic Uniform State.
Group cover letters can be submitted with Biographical affidavits that are used for officer/director changes and for expansion and corporate amendment applications (The affiant and notary signatures on the biographical affidavit must be within 6 months of the date of submission) for companies listed on the group cover letter and are under the same group code. Only the 不良研究所官方 cover letter can be submitted with a UCAA. Unless otherwise noted below all uniform states accept the group cover letter when a biographical affidavit is required.
Last Updated: 11/06/2024
Updates to the information will be noted with a 鈥 * 鈥 next to the state name and edits will be italicized and bolded.
| State |
Domiciliary Requirements for initial Licensure (Primary) or Other Application Types (Redomestication, Form A, Domestic Corporate Amendment) |
Domestic Requirements (Updates Only, e.g. Annual, new officer, etc.) |
State Contact Information |
|---|---|---|---|
| AL |
Primary Application: 不良研究所官方 Biographical Affidavit AND Independent Third-Party Verification |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: admissions@insurance.alabama.gov |
| *AK |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification |
不良研究所官方 Biographical Affidavits are not required. |
Biographical Affidavit: Primary/Redomestications: Jeffery Bethel P: (907) 269-7919 F: (907) 269-7898 jeffery.bethel@alaska.gov Corporate Amendments Applications: Third-Party Verification Reports: |
| AZ |
Primary Application: 不良研究所官方 Biographical Affidavit AND Independent Third-Party Verification |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit: Erica Bowsher erica.bowsher@difi.az.gov Third-Party Verification Reports: |
| *AR |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: |
| *CA |
Primary Application: Yes, Fingerprints and 不良研究所官方 Biographical Affidavits. Please contact California's Department of Insurance directly at (415) 538-4035 to request the necessary fingerprint live scan |
After Licensure: 不良研究所官方 Biographical Affidavits and fingerprint are required for changes in Officers, Directors or Key Managerial Personnel. Disclaimer of Control: Allowed |
Biographical Affidavit: CAB-SF-Intake@insurance.ca.gov or 415-538-4035 Third-Party Verification Reports: |
| CO |
Primary Application: 不良研究所官方 Biographical Affidavit, Fingerprints and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: Cindy Hathaway dora_ins_corporateaffairs@state.co.us |
| *CT |
Primary Application: 不良研究所官方 Biographical Affidavits and Independent Third-Party Verification. |
不良研究所官方 Biographical Affidavits are required when there is a change in or new officers, directors, and key managerial as soon as possible. |
Biographical Affidavit: Third-Party Verification Reports: |
| *DE |
Primary Application: 不良研究所官方 Biographical Affidavit and Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit: BERG@Delaware.gov Third-Party Verification Reports: |
| DC |
Primary Application: 不良研究所官方 Biographical Affidavits and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: Nathaniel Kevin Brown Director - Financial Examinations, Insurance Bureau Department of Insurance, Securities and Banking 1050 First Street, NE, Suite 801 Washington, DC 20002 Telephone (202)442-7785 Nathaniel.Brown@dc.gov |
| *FL |
Primary Application: Licensure: 不良研究所官方 Biographical Affidavit, Independent Third-Party Verification and Fingerprint Cards (Fingerprint LiveScan available for Florida Residents Only). Refer to State Specific Requirements for Fingerprint Procedures. Please contact the Office of Insurance Regulation at (850) 413-2575 to request the necessary fingerprint cards or FPRequest@floir.com. Redomestication Application: Same as Primary Form A: Same as Primary Domestic Corporate Amendment: Not required
|
After Licensure: Any change in officer/director requires 不良研究所官方 Biographical Affidavit, Independent Third-Party Verification and Fingerprint Cards (Fingerprint LiveScan available for Florida Residents Only). Refer to State Specific Requirements for Fingerprint Procedures. Please contact the Office of Insurance Regulation at (850) 413-2575 to request the necessary fingerprint cards or FPRequest@floir.com. | Biographical Affidavit: Life & Health Companies: Joe Erhart, Applications Coordinator Phone 850-413-5066 Email joe.erhart@floir.com) Property & Casualty Companies: Wesley White Applications Coordinator Phone 850-413-5225 Email wesley.white@floir.com Third-Party Verification Reports: bkgrnd-inv@floir.com |
| GA |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification |
Contact state for requirements. |
Biographical Affidavit: RegServices@oci.ga.gov Third-Party Verification Reports: |
| HI |
Contact state for requirements. |
Contact state for requirements. | Contact state. |
| ID |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification |
After Licensure: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification report is required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: doi.companyactivities@doi.idaho.gov |
| *IL |
Primary Application: Current Version of the 不良研究所官方 Biographical Affidavits with original signatures and the bios shall be notarized required for all domestic companies鈥 Officers and Directors. Independent Third-Party Verification Reports are required for all Officers and Directors. |
After Licensure: Current Version of the 不良研究所官方 Biographical Affidavits with original signatures and being notarized are required for changes in Officers or Directors; Independent Third-Party Verification Reports are required for new Officers or Directors. Notification of a change in officers or directors is required within 30 days. |
Biographical Affidavit: Life, Accident & Health Companies: Third-Party Verification Reports: |
| IN |
with electronic signature which complies with the electronic transaction act (IETA)) and Independent Third-Party Verification required for all domestic companies Note: Electronic signatures from commercially available software, such as Docusign or Esign, are acceptable. 鈥淐heck the Box鈥 signatures or 鈥淩ubber Stamp鈥 signatures Do Not Comply. Disclaimer of Control: Allowed |
Electronically signed are required for changes in Officers, Directors or Key Managerial Personnel. Note: Electronic signatures from commercially available software, such as Docusign or Esign, are acceptable. 鈥淐heck the Box鈥 signatures or 鈥淩ubber Stamp鈥 signatures Do Not Comply. |
Application Submissions Form A, Corporate Amendment Updates |
| *IA |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification |
After Licensure: 不良研究所官方 Biographical Affidavits and Independent Third-Party verification are required for changes in Officer, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: Dana Sanders company.licensing@iid.iowa.gov or Iowa Insurance Division Attn: Dana Sanders 1963 Bell Avenue Des Moines, Iowa 50315 |
| KS | Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. Redomestication Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. Form A: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. Domestic Corporate Amendment: None Disclaimer of Control: Contact state |
After Licensure: 不良研究所官方 Biographical Affidavit for changes in Officers and Directors as listed on page one of the annual statement within 30 days after the changes or actions become effective or are otherwise finalized. |
Biographical Affidavit and Third-Party Verification Reports: Third-party background reports should be sent electronically (via e-mail) to the following state contact: |
| KY |
Contact state for requirements. |
Contact state for requirements. | Contact state. |
| LA |
Primary Application: Complete Biographical Affidavits (Form 11) on most current form for all Officers and Directors. Independent Third-Party Verifications required for all Officers and Directors. Domestic applicants must submit fingerprints in compliance with the state requirements. More information on fingerprint requirements at . |
After Licensure: Complete Biographical Affidavits (Form 11) on most current form for all new Officers and Directors. Independent Third-Party verifications required for all new Officers and Directors. All new Officers and Directors must submit fingerprints in compliance with state requirements. More information on fingerprint requirements at . |
Biographical Affidavit and Third-Party Verification Reports: Tangela Byrd Insurance Manager Louisiana Department of Insurance 1702 North 3rd Street (70802) P.O. Box 94214 Baton Rouge, LA 70804-9214 Tangela.Byrd@ldi.la.gov |
| ME | Contact state for requirements. | Contact state for requirements. | Contact state. |
| MD |
Primary Application: 不良研究所官方 Biographical Affidavits and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits with original signatures are required for changes in Officers, Directors. Independent Third-Party Verifications are required for new Officers or Directors. Notification of a change in Officers or Directors is required within 3-days. |
Biographical Affidavit and Third-Party Verification Reports: Erin Nickels Mailing address: Maryland Insurance Administration 200 St. Paul Place, Suite 2700 Baltimore, Maryland 21202 Email address: Colicensing.mia@maryland.gov |
| MA |
Contact state for requirements. |
Contact state for requirements. | Contact state. |
| MI |
Primary Application: 不良研究所官方 Biographical Affidavit dated within 6 months of filing application and Independent Third-Party Verification Report required |
After Licensure: 不良研究所官方 Biographical Affidavit dated within 6 months of change and Independent Third-Party Verification are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: Third party verifications should be sent directly to DIFS by the third-party verifier. Send to : Linda Martin, Application Coordinator, 517-284-8756 or martinl@michigan.gov If reports cannot be sent electronically, hard copies should be sent to: Linda Martin, Application Coordinator Michigan Department of Insurance and Financial Services Office of Insurance Financial and Market Regulation P. O. Box 30220 Lansing, MI 48909 OR 530 W. Allegan St., 7th Fl. Lansing, MI 48933 |
| MN |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verifications are required for Primary Applications. Signatures must be original, and dated within 6 months of application. |
After Licensure: Any new individual on the Jurat page must submit an 不良研究所官方 Biographical Affidavit dated within 6 months, original or digital signatures are accepted. |
不良研究所官方 Biographical Affidavit: Domestic companies should submit to insurance.commerce@state.mn.us within 60 days of the change. |
| MS |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verifications are required for Primary Applications. Signatures must be original. |
Notification and a 不良研究所官方 Biographical Affidavit are required for all new officers and directors |
Biographical Affidavit: Chad Bridges Email: Chad.Bridges@mid.ms.gov Phone #: 601-359-2136 Third-Party Verification Reports: |
| MO |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. |
|
Biographical Affidavit: InsuranceSolvency@insurance.mo.gov (573)526-4877 Third-Party Verification Reports: |
| MT |
Primary Application: 不良研究所官方 Biographical Affidavit |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: |
| NE |
Primary Application: UCAA biographical affidavit and 3rd party verifications, no fingerprints |
All officer, director, or key personnel changes require biographical affidavit |
Primary Application, Redomestication, Corporate Amendments: Lindsay.Crawford@nebraska.gov Officer Updates: TJ.Addison@nebraska.gov |
| NV |
Contact state for requirements. |
Contact state for requirements. | Contact state. |
| NH |
Primary Application: 不良研究所官方 Biographical Affidavit |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavits; Third-Party Verification Reports only if requested: linda.m.zalinskie@ins.nh.gov |
| NJ |
Primary Application: Primary P&C - 不良研究所官方 Biographical Affidavit and criminal history record check by the New Jersey State Police. Link: . Once at the website enter Originating Agency Identifier (ORI) #: NJDINS11X. Primary L&H: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. Contact the Department for state specific information (Solvency Regulation 609-292-7272). |
After Licensure P&C: 不良研究所官方 Biographical Affidavit and criminal history record check by the New Jersey State Police. After Licensure L&H: 不良研究所官方 Biographical Affidavit, and Independent Third-Party Verification. |
Biographical Affidavit and Third-Party Verification Reports: |
| NM |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits submitted in hard copy for changes in Officers/Directors. |
Biographical Affidavit and Third-Party Verification Reports: Ursula Almada Ursula.Almada@osi.nm.gov Victoria Baca Victoriaa.Baca@osi.nm.gov
|
| *NY |
Primary Application: 不良研究所官方 Biographical Affidavit AND Independent Third-Party Verification |
After Licensure: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports:鈥&苍产蝉辫; Third party verification reports should be sent directly to NY DFS by the third-party vendor using the (an account is not required). A copy of the biographical affidavit is required to be included with the report. State Email Contacts: |
| NC |
Contact state for requirements. |
Contact state for requirements. | Contact sate. |
| ND |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit: 鈥嬧嬧婱att Fischer mattfischer@nd.gov or Nichole Feldman nrfeldman@nd.gov Third-Party Verification Reports: |
| OH |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. | Biographical Affidavit and Third-Party Verification Reports: Cam Piatt clyde.piatt@insurance.ohio.gov 614 728-1074 |
| OK |
Contact state for requirements. |
Contact state for requirements. | Contact state. |
| OR |
Contact state for requirements. |
Contact state for requirements. | Contact state. |
| PA |
Primary Application: 不良研究所官方 Biographical Affidavit |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit: Diana L. Sherman Acting Deputy Commissioner 1345 Strawberry Square Harrisburg, PA 17120 Phone: 717.503.5462 Email: disherman@pa.gov Third-Party Verification Reports: Not Required |
| *PR |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: Glorimar Santiago gsantiago@ocs.pr.gov Maria Morcelo mariamorcelo@ocs.pr.gov |
| RI |
Contact State |
不良研究所官方 Biographical Affidavit is required for new Officers and Directors within a reasonable time frame. |
Biographical Affidavit and Third-Party Verification Reports: Ted Hurley ted.hurley@dbr.ri.gov |
| SC |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification are required. |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: |
| SD |
Primary Application: 不良研究所官方 Biographical Affidavit |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors, or Key Managerial Personnel |
Biographical Affidavit: Third Party Verification Reports: |
| TN |
Primary Application: Biographical affidavits and third-party background checks of board members and officers. |
Biographical affidavits and third-party background checks of new board members and officers. |
Biographical Affidavit and Third-Party Verification Reports: Hui Wattanaskolpant hui.wattanaskolpant@tn.gov
|
| TX |
Primary Application: 不良研究所官方 Biographical Affidavit, Identogo Fingerprint receipts, and Independent Third-Party Verifications for all directors and only the following officers: CEO, President, Executive Director, Secretary, Treasurer, CFO/Controller, COO and Medical Director (if applicable) and any individuals that own 10% or more, beneficial ownership in the Applicant Company and the Applicant |
After Licensure: 不良研究所官方 Biographical Affidavits and Fingerprint receipts are required for changes to Domestic insurers directors and only the following officers: CEO, President, Executive Director, Secretary, Treasurer, CFO/Controller, COO and Medical Director (if applicable). We DO NOT require biographical affidavits for Vice Presidents or Assistant-officers. |
Biographical Affidavit: Laura Weld laura.weld@tdi.texas.gov Third-Party Verification Reports: |
| *UT |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification are required for changes in Directors, Officers and Key Managerial Personnel of domestic company or ultimate controlling person. |
Biographical Affidavit and Third-Party Verification Reports: Jay Sueoka jsueoka@utah.gov or company-renewals@utah.gov |
| VT |
Primary Application: 不良研究所官方 Biographical Affidavit & Third-Party Verification is required. |
After Licensure Updates: 不良研究所官方 Biographical Affidavit; Independent Third-Party Verification may be required. |
Biographical Affidavit: (802)-828-2470 or dfr.complic@vermont.gov Third-Party Verification Reports: |
| VA |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: Kevin McClain Financial Analyst Direct Line: (804) 371-9432 Kevin.McClain@scc.virginia.gov |
| WA |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. Domestic insurers must file a biographical affidavit every thirty-six months after the last biographical affidavit filed. |
Biographical Affidavit: Jason Carr jason.carr@oic.wa.gov Third-Party Verification Reports: |
| WV |
Primary Application: 不良研究所官方 Biographical Affidavit is required. |
After Licensure: 不良研究所官方 Biographical Affidavit is required for new officers and/or directors AND amendments to officers and/or directors. |
WV Offices of the Insurance Commissioner *Do not email Bio's to the above email. They can be viewed in UCAA or sent to: WV Offices of the Insurance Commissioner Third-Party Verification Reports: |
| WI |
Primary Application: 不良研究所官方 Biographical Affidavit required (but not fingerprints or Independent Third-Party Verifications) |
After Licensure: 不良研究所官方 Biographical Affidavit required for any changes in Directors, Officers or Key Managers (but not fingerprint or Independent Third-Party Verifications). |
Biographical Affidavit: Third-Party Verification Reports: |
| WY |
Primary Application: 不良研究所官方 Biographical Affidavit and Independent Third-Party Verification. |
After Licensure: 不良研究所官方 Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. |
Biographical Affidavit and Third-Party Verification Reports: Doug Melvin doug.melvin@wyo.gov |