Connecticut Insurance Department Forms

This form is used for filing a surplus lines statement in Connecticut.

This Form is used for informing Connecticut residents about the option to continue their health insurance coverage. It provides details on how to elect for continuation coverage and the necessary deadlines.

This form is used for canceling or terminating a license in the state of Connecticut.

This document is used to request the rescission, cancellation, or limitation of a health insurance policy in the state of Connecticut.

This document grants power of attorney to a nonresident non-corporation to act as a reinsurance intermediary in the state of Connecticut.

This document provides an annual report for a bail bond surety company in Connecticut, summarizing their financial performance and activities throughout the year. It includes information about their revenues, expenses, assets, and liabilities.

This document is for registering as a Third Party Administrator (TPA) in the state of Connecticut.

This document is used for appointing a bail bond agent in the state of Connecticut. It is an affidavit that confirms the appointment of the agent and their responsibilities in the bail bond process.

This document grants a nonresident individual the authority to act as a reinsurance intermediary on behalf of an insurance company in the state of Connecticut.

This document is used for applying for recognition under the Connecticut Captive Insurance Company Actuarial Services. It includes the services and opinions related to loss reserves and expense certification.

This document is an application form used for obtaining recognition as a captive insurance company manager in the state of Connecticut.

This document is used for applying for recognition as an independent certified public accountant for a captive insurance company in Connecticut.

This Form is used for filing consumer complaints in the state of Connecticut.

This Form is used for requesting a change of residency when moving to or from Connecticut.

This document is the initial license application form for individuals or businesses seeking to become surety bail bond agents in the state of Connecticut.

This form is used for individuals in Connecticut who want to register as a life settlement broker to act as a life producer.

This form is used for registering as a life producer to act as a life settlement broker in the state of Connecticut.

This Form is used for renewing the application of a life settlement provider in the state of Connecticut.

This document is used for applying for an individual fraternal agent license or appointment in the state of Connecticut.

This document is for the renewal application of a Pharmacy Benefits Manager (PBM) Certificate of Registration in the state of Connecticut. It is used by companies or organizations involved in managing prescription drug benefits for health insurance plans.

This document is used for granting authority to a nonresident corporation to act as a reinsurance intermediary in the state of Connecticut.

This document is used for applying for a permit to operate a rental car agency in the state of Connecticut.

This document is for auditing the findings of a bail bond surety company in Connecticut.

This Form is used for scheduling an appointment with a rental car agency company in Connecticut.

This form is used for obtaining a Preferred Provider Network (PPN) license in the state of Connecticut. It is required for individuals or organizations looking to establish a network of medical providers that offer discounted rates to members of the network.

This Form is used for applying for a portable electronic insurance license in the state of Connecticut.

This Form is used for obtaining a Certificate of Assuming Insurer in the state of Connecticut. It is a document that allows an insurance company to assume the policies of another insurance company.

This form is used for renewing a Preferred Provider Network (PPN) license in Connecticut.

This form is used for renewing your premium finance agreement with a company in Connecticut.

This document is an application form for vendors who want to be qualified to provide behavioral health clinical review criteria in Connecticut. The form is used to assess the qualifications and eligibility of vendors interested in this opportunity.

This Form is used for applying for a Certificate of Registration as a Pharmacy Benefits Manager in the state of Connecticut.

This form is used for providing additional information for a consumer report card pertaining to all networks in Connecticut.

This form is used for establishing a general agent agreement in the state of Connecticut.

This document is an application for obtaining a license as a Life Settlement Provider in the state of Connecticut. It is used by individuals or companies who wish to engage in the business of buying life insurance policies from policyholders.

This document provides instructions on how to report insurance fraud in the state of Connecticut. It outlines the necessary steps to take and the information required to file a report.

This form is used for the annual certification of Professional Employer Organizations (PEOs) in Connecticut. PEOs are companies that provide human resources and employee benefits services to other businesses. This certification ensures that PEOs in Connecticut meet certain standards and regulations.

This Form is used for applying for a Utilization Review License in the state of Connecticut. It is necessary for individuals or organizations looking to provide utilization review services in Connecticut.

This form is used for renewing a Medical Discount Plant (MDP) license in Connecticut.