Louisiana Department of Insurance Forms

This document is an application for individuals or organizations to act as a discount medical plan in the state of Louisiana.

This form is used for applying to become a registered Professional Employer Organization (PEO) in the state of Louisiana.

This form is used to report a cybersecurity event in Louisiana. It is important to report any suspicious cyber activities to help maintain the security of computer systems and protect sensitive information.

This document is used for calculating the loss cost multiplier for lines other than workers' compensation in Louisiana.

This document is a worksheet used in Louisiana for calculating the loss cost multiplier for workers' compensation insurance.

This document is used for certifying an information security program in accordance with the Louisiana Insurance Data Security Law.

This form is used for obtaining an exemption certification for the Information Security Program under the Louisiana Insurance Data Security Law.

This document is an application for approval to be a pharmacy services administrative organization in the state of Louisiana.

This document is for applying to be a specialty insurer in the state of Louisiana.

This form is used for obtaining consent or a waiver according to Louisiana Revised Statutes 22:1554(A)(18). It is for specific legal purposes in Louisiana.

This Form is used for reporting tax information related to direct placements with surplus line insurers or other unauthorized insurers in Louisiana.

This form is used for applying to register a Risk Purchasing Group in the state of Louisiana.

This document is a request for the Commissioner in Louisiana to hold a deposit on behalf of an insurer. It is used in cases where an insurer needs to provide a deposit as a requirement for conducting business in the state.

This document is for those who want to become a workers' compensation self-insurance fund in the state of Louisiana. It is an application form that needs to be filled out and submitted to the relevant authorities.

This document is used for obtaining a certificate of a reinsurer domiciled in a reciprocal jurisdiction in the state of Louisiana.

This document is a form used to apply for a Resident or Nonresident Reinsurance Intermediary Broker or Manager license in the state of Louisiana.

This document is used for requesting a pre-application eligibility determination in the state of Louisiana.