Kentucky Department of Insurance Forms

This form is used for applying for an individual insurance license in the state of Kentucky.

This Form is used for applying for a business entity insurance license in Kentucky.

This Form is used for documenting a consumer's refusal to provide information in the state of Kentucky.

This form is used for the certification of government entity status in the state of Kentucky.

This document is for consumers in Kentucky who are considering purchasing an annuity. It explains that the decision to purchase an annuity should not be based solely on a recommendation, but rather on the individual's personal financial needs and goals.

This form is used for calculating the Loss Cost Multiplier with Expense Constants for Property and Casualty expenses in Kentucky.

This form is used for actuarial certification for individual health insurance plans in Kentucky.

This form is used for calculating the Loss Cost Multiplier for Property and Casualty Insurance in the state of Kentucky.

This Form is used for providers of life settlement services to obtain certification in the state of Kentucky.

This form is used for requesting additional health information in the state of Kentucky.

This Form is used for filing rate information for limited benefits in the state of Kentucky.

This form is used for filing health summary sheets in Kentucky. It provides a summary of an individual's health information.

This form is used for calculating and requesting refunds for Medicare supplement plans in the state of Kentucky.

This Form is used for applying for a Certificate of Filing as a Provider-Sponsored Integrated Health Delivery Network in the state of Kentucky.

This Form is used for notifying the decision of external review regarding the HIPMC-IRE-3 in Kentucky.

This form is used for submitting quarterly financial statements of an insurance purchasing outlet in the state of Kentucky.

This form is used for applying for a Certificate of Filing as a Liability Self-insurance Group in Kentucky. It is required for groups that want to self-insure their liability coverage instead of purchasing insurance from a traditional insurance company.

This form is used for the annual call for data for medical professional liability insurance in Kentucky. It is specifically for Property and Casualty (P&C) insurance providers.

This form is used for applying for self-insurance for a motor vehicle in the state of Kentucky. Self-insurance allows individuals to provide proof of financial responsibility for the vehicle instead of purchasing traditional auto insurance coverage.

This form is used for the LSIG trustee to confirm the receipt of liability self-insured group quarterly financial statements in Kentucky.

This form is used for applying for authorization to certify loss reserves and loss expense reserves for captives in Kentucky.

This form is used for filing the quarterly statement for a liability self-insurance group in the state of Kentucky.

This form is used for applying to become an Independent Certified Public Accountant for captive insurance business in Kentucky.

This form is used for workers' compensation self-insured groups in Kentucky to elect safekeeping of securities.

This Form is used for requesting a letter of credit in the state of Kentucky.

This Form is used for reporting transactions of securities held under safekeeping in Kentucky.

This form is used for trustees to confirm the receipt of workers' compensation self-insured group quarterly financial statements in Kentucky.

This form is used for workers' compensation group security deposit held under safekeeping in Kentucky.

This document is used for the initial application for a Certificate of Filing as a Workers' Compensation Self-insured Group in Kentucky. It is necessary for groups wishing to provide self-insurance for workers' compensation in the state.

This document provides a disclosure for insurance agents (producers) selling annuities in Kentucky. It contains important information about how annuities work and the responsibilities of the insurance agent.

This Form is used for verifying coverage of life insurance policies in the state of Kentucky.

This Form is used for requesting corrections to Kentucky state records.

This Form is used for providing information about a Risk-Sharing Arrangement in Kentucky.