Last update: 07/22/2024
Updates to the information will be noted with a “*” next to the state name and edits will be italicized and bolded.
| Biographical Affidavits | Uniform Consent to Service of Process (Form 12) | |||||||
|---|---|---|---|---|---|---|---|---|
| State | Required: Yes or No | Additional Outside of Electronic Signature | State Specific Form |
Background Report Required? |
Required | Additional Outside of Electronic Signature | State Specific Form |
Designated Agent |
| AL | Expansion App: Yes Corp Amend App: Contact state New Officer/ Update: Contact state |
Contact state | Contact state | Yes | Expansion App: Yes Corp Amend App: Contact state |
Contact state | Contact state | Commissioner of Insurance # and Resident Agent* |
| AK |
Expansion App: Yes |
No | No | No |
Expansion App: Yes |
No | No | Director of Insurance # |
| *AZ | Expansion App: Yes Corp Amend App: No New Officer/ Update: No |
Expansion App: Yes Corp Amend App: No New Officer/ Update: No |
Expansion App: Yes Corp Amend App: Yes |
No | Director of Insurance # ^ | |||
| AR |
Expansion App: Yes |
No | No | This depends on the facts/situation. |
Expansion App: No |
No | No | Resident Agent |
| *CA |
Expansion App: Yes Redomestication App: Contact State Form A App: Yes |
No | No | Expansion App: Yes Corp Amend App: Yes, if new agent is appointed, insurer changes its name or redomesticates |
* see additional requirements |
CDI-021 |
Resident Agent | |
| *CO | Expansion App: Yes Corp Amend App: No New Officer/ Update: Contact State |
An original signature and notarization are required; however, electronic signatures are acceptable if generated using an approved electronic signature platform.
For Form 15 original or wet signature is required. |
No | Yes | Expansion App: Yes Corp Amend App: Yes, required for Change in Statutory Home Office, and Name Change. |
An original signature is required; however, electronic signatures are acceptable if generated using an approved electronic signature platform. |
Contact state | Resident Agent* |
| CT |
Expansion App: Yes |
None | None | Yes |
Expansion App: Yes |
None | None | Commissioner of Insurance # |
| *DE | Expansion App: Yes Corp Amend App: Yes, if new officers New Officer/ Update: No |
No | No | Expansion App: Yes | Expansion App: Yes Corp Amend App: Yes, if changing from current |
No | No | Commissioner of Insurance # |
| *DC | Expansion App: Yes Corp Amend App: Contact District New Officer/ Update: Contact District |
Contact state | Contact state | Yes | Expansion App: Yes Corp Amend App: Contact District |
Contact state | Contact state | Commissioner of Insurance, Securities and Banking # or Resident Agent* |
| *FL | Expansion App: Yes Corp Amend App: No New Officer/ Update: Yes |
Yes | No | Yes | Expansion App: Yes Corp Amend App: Only if Info Has Changed |
No | No | Chief Financial Officer # ^ |
| GA | Expansion App: Yes, both UCAA Biographical Affidavit and 3rd Party Background checks required Corp Amend App: UCAA Biographical affidavit only New Officer/ Update: UCAA Biographical affidavit only |
No | No | Yes | Expansion App: Yes Corp Amend App: Yes |
No | Yes | Commissioner of Insurance and Safety Fire # and Resident Agent* |
| HI* | Yes | No | Yes | Yes | Yes | Contact state | Insurance Commissioner # and Resident Agent* | |
| ID | Expansion App: Yes Corp Amend App: No New Officer/ Update: No |
Electronic or Wet including Notary | No | Yes | Expansion App: Yes Corp Amend App: Yes |
No | No | Director of Insurance #^ |
| IL | Expansion App: Yes Corp Amend App: No New Officer/ Update: Yes |
No | No | Yes | Expansion App: Yes Corp Amend App: No |
No | Yes for Expansion Applications | Director of Insurance # |
| IN |
Expansion App: Yes |
No | No | Expansion: Yes Corp Amend & New Officer/Update: No |
Expansion App: Yes |
No | No | Resident Agent*^ |
| IA | Expansion App: Yes Corp Amend App: Yes New Officer/ Update: Contact state |
Yes | Yes, must comply with IA Code Chapter 554D | Yes | Expansion App: Yes Corp Amend App: Yes |
Yes | Yes, must comply with IA Code Chapter 554D | Commissioner of Insurance # |
| KS | Expansion App: Yes Corp Amend App: Contact state New Officer/ Update: Contact state |
N/A | No | Yes | Expansion App: Yes Corp Amend App: Contact state |
N/A | No | Commissioner of Insurance ^ |
| KY | Yes | No | Yes | Yes | No | Secretary of State # | ||
| LA# |
Expansion App: Yes |
Contact state | No | Expansion: Yes Corp Amend & New Officer/Update: No |
Expansion App: Yes |
Contact state | No | Secretary of State # |
| ME | Yes | Yes | Yes | Yes | Yes | Resident Agent* ^ | ||
| MD | Expansion App: Yes Corp Amend App: Yes New Officer/ Update: Yes |
No | No | Yes | Expansion App: Yes Corp Amend App: Yes |
No | No | Insurance Commissioner # |
| MA* | Yes | No | No | No | No | |||
| MI | Expansion App: Yes Corp Amend App: No New Officer/ Update: No |
Electronic signature acceptable if completed using an approved electronic signature platform. | No | Expansion Application: Yes | Expansion App: Yes Corp Amend App: Yes (depending on corp amendment type) |
Electronic signature acceptable if completed using an approved electronic signature platform. | No | Resident Agent * |
| MN | Expansion App: Yes Corp Amend App: As required by the UCAA filing New Officer/ Update: No |
Additional not needed | Contact state | Yes, for expansion applications | Expansion App: Yes Corp Amend App: As required by UCAA filing |
Contact state | Contact state | Resident Agent~ |
| MS |
Expansion App: Yes |
Contact state | No | No |
Expansion App: Yes |
Contact state | No |
Commissioner of Insurance and Resident Agent* BOTH are required. |
| MO | Expansion App: Yes Corp Amend App: Contact state New Officer/ Update: Contact state |
Contact state | No | Yes | Expansion App: Yes Corp Amend App: Contact state |
Contact state | Contact state | Director of Insurance # |
| MT | Expansion App: Yes Corp Amend App: Yes New Officer/ Update: Yes |
Contact state | No | No | Expansion App: Yes Corp Amend App: Yes |
Contact state | No | Resident Agent* |
| NE |
Expansion App: Yes |
No | No |
Expansion App: Yes |
Expansion App: Yes |
No | No | Officer of Company* or Resident Agent* |
| NV | No | No | No | No | Yes | No | No | Commissioner of Insurance Commission # ^ |
| *NH | Expansion App: Yes Corp Amend App: Yes New Officer/ Update: No |
Contact state | No | No | Contact state | Contact state | No | Commissioner of Insurance # |
| NJ | Expansion App: Yes Corp Amend App: Yes New Officer/ Update: Yes |
No | No | No | Expansion App: Yes Corp Amend App: Yes, If any changes to NAIC Form 12 |
Yes | No | Commissioner of Banking and Insurance #^ |
| NM | Expansion App: Yes Corp Amend App: YES New Officer/ Update: Cover letter sent to the OSI indicating changes. |
Yes | No | Yes | Expansion App: Yes Corp Amend App: Yes |
Yes | No | Superintendent of Insurance # |
| *NY | Expansion App: Yes Corp Amend App: Yes New Officer/ Update: Yes |
Contact state | No | Expansion App: Yes Corp Amend App: Yes New Officer/ Update: Yes |
Expansion App: Yes Corp Amend App: Contact state |
Contact state | Contact state | Superintendent of Financial Services # |
| NC | Yes | No | No | No | Yes | No | No | Commissioner of Insurance |
| ND | Expansion App: Yes Corp Amend App: No New Officer/ Update: No |
No | No | Yes | Expansion App: Yes Corp Amend App: No |
No | No | Commissioner of Insurance # ^ |
| OH | Expansion App: Yes Corp Amend App: Contact state New Officer/ Update: Contact state |
Contact state | Contact state | Yes | Expansion App: Yes Corp Amend App: Contact state |
Contact state | Contact state | Resident Agent* |
| OK | Yes | Yes | Yes | Yes | Yes | Commissioner of Insurance # | ||
| OR | Yes | No | No | Yes | Yes | Resident Agent* | ||
| PA** | Expansion App: Yes Corp Amend App: Contact state New Officer/ Update: Contact state |
Contact state | Contact state | No | Expansion App: No Corp Amend App: No |
Contact state | Contact state | Contact state |
| PR | Contact State | Contact state | Contact state | No | Expansion App: Yes Corp Amend App: Yes |
No | No | Commissioner of Insurance # |
| RI |
Expansion App: Yes |
Yes | No | No |
Expansion App: Yes |
Yes | No | Superintendent of Insurance ^ |
| SC |
Expansion App: Contact state |
Yes | No | Yes |
Expansion App: Contact state |
Yes | No | Director of Insurance # |
| SD |
Expansion App: Contact state |
No | No |
Expansion App: Contact state |
Yes | Yes | Director of Insurance # ^ | |
| TN |
Expansion App: Yes |
No | No | No |
Expansion App: Yes |
No | No | Commissioner of Insurance # |
| TX | Expansion App: Yes Corp Amend App: Only if officer/director changes have been made New Officer/ Update: Yes for President, Treasurer, Secretary |
Contact state | Contact state | Yes | Expansion App: Yes Corp Amend App: Only if officer/director changes have been made |
No | Contact state | Resident Agent* |
| UT | Expansion App: Yes Corp Amend App: Contact state New Officer/ Update: Contact state |
Contact state | Contact state | Yes | Expansion App: Yes Corp Amend App: Contact state |
Contact state | Contact state | Resident Agent* |
| VT | Expansion App: Yes Corp Amend App: No New Officer/ Update: No |
No | No | No | Expansion App: Yes Corp Amend App: Yes |
No | No | Resident Agent* |
| VA | Expansion App: Yes Corp Amend App: Contact state New Officer/ Update: Contact state |
Contact state | Contact state | Yes | Expansion App: No Corp Amend App: Contact state |
Contact state | Yes | Contact state |
| WA | Expansion App: Yes Corp Amend App: Yes New Officer/ Update: Yes |
No | No | Yes | Expansion App: Yes Corp Amend App: Yes |
No | No | Insurance Commissioner # |
| *WV | Expansion App: Yes Corp Amend App: No New Officer/ Update: No |
Contact state | No | No | Expansion App: Yes Corp Amend App: No, unless amended |
Contact state | No | Secretary of State # |
| WI | Expansion App: Yes Corp Amend App: Contact state New Officer/ Update: Contact state |
Contact state | Contact state | No | Expansion App: No Corp Amend App: Contact state |
Contact state | Yes | Contact state |
| *WY | Expansion App: Yes # Corp Amend App: Yes # New Officer/ Update: Yes # |
Contact state | Contact state | Yes | Expansion App: Yes # Corp Amend App: Yes # |
No | No | Commissioner of Insurance # |
*Reserves the right to request originals
**Will accept copies if originals are on file with the state of domicile
#Will accept electronic signatures
^ If filed in hard copy “wet signatures” required but if submitted through the electronic application, electronic signatures or copies accepted.
Form 12 - Consent to Service of Process
* CA - ALL - Board Resolution - A certified copy of the applicant's board resolution authorizing the amendment and application. California Corporations Code § 300(a).