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Domestic Fingerprints and Biographical Affidavit Requirements
Domestic Fingerprint and Biographical Affidavit Requirements

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 NAIC 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: 07/19/2024
Updates to the information will be noted with a “ * ” 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: NAIC Biographical Affidavit AND Independent Third-Party Verification
Redomestication Application: Contact state
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC 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: NAIC Biographical Affidavit and Independent Third-Party Verification
Redomestication Application: Not required
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification
Domestic Corporate Amendment: Not required
Disclaimer of Control: Allowed

NAIC 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:
Kevin Richard
P: (907) 269-7903
F: (907) 269-7910
kevin.richard@alaska.gov

Third-Party Verification Reports:
Secure email to:
jeffery.bethel@alaska.gov
kevin.richard@alaska.gov
OR
Mail to:
Alaska Division of Insurance
550 W 7th Avenue, Suite 1560
Anchorage, AK 99501-3567

AZ

Primary Application: NAIC Biographical Affidavit AND Independent Third-Party Verification
Redomestication Application: NAIC Biographical Affidavit AND Independent Third-Party Verification
Form A: NAIC Biographical Affidavit AND Independent Third-Party Verification
Domestic Corporate Amendment: Not Applicable
Disclaimer of Control: Allowed
 

After Licensure: NAIC 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:
financialfilings@difi.az.gov

*AR

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification - Ark. Code Ann. § 23-63-218
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification - Ark. Code Ann. §§ 23-63-506 – 513
Domestic Corporate Amendment: NAIC Biographical Affidavit and Independent Third-Party Verification - Ark. Code Ann. § 23-69-107
Disclaimer of Control: Not Allowed

After Licensure: NAIC Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel.

Biographical Affidavit and Third-Party Verification Reports:
Kimberly Johnson
501-371-2680
Insurance.Finance@arkansas.gov 
Insurance.Legal@arkansas.gov

*CA

Primary Application: Yes, Fingerprints and NAIC Biographical Affidavits. Please contact California's Department of Insurance directly at (415) 538-4035 to request the necessary fingerprint live scan
Redomestication Application: Contact State
Form A: Yes
Domestic Corporate Amendment: Contact State

After Licensure: NAIC 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:
Not Applicable - State Completes

CO

Primary Application: NAIC Biographical Affidavit, Fingerprints and Independent Third-Party Verification. 
Redomestication Application: NAIC Biographical Affidavit, Fingerprints and Independent Third-Party Verification. 
Form A: NAIC Biographical Affidavit, Fingerprints and Independent Third-Party Verification. 
Domestic Corporate Amendment: n/a
Disclaimer of Control: Allowed

After Licensure: NAIC 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: NAIC Biographical Affidavits and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavits and Independent Third-Party Verification.
Form A: NAIC Biographical Affidavits and Independent Third-Party Verification.
Domestic Corporate Amendment: Yes
Disclaimer of Control: Not Allowed

NAIC Biographical Affidavits are required when there is a change in or new officers, directors, and key managerial as soon as possible.

Biographical Affidavit: 
cid.finregfilings@ct.gov
860-297-3800

Third-Party Verification Reports:
Contact state

*DE

Primary Application: NAIC Biographical Affidavit and Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavit and Third-Party Verification.
Form A: NAIC Biographical Affidavit and Third-Party Verification.
Domestic Corporate Amendment: if applicable
Disclaimer of Control: Not Allowed

After Licensure: NAIC Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. 

Biographical Affidavit: 
BERG@Delaware.gov

Third-Party Verification Reports:
BERG@Delaware.gov

DC

Primary Application: NAIC Biographical Affidavits and Independent Third-Party Verification.
Redomestication Application: Contact Jurisdiction
Form A: Contact Jurisdiction
Domestic Corporate Amendment: Contact Jurisdiction
Disclaimer of Control: Allowed

After Licensure: NAIC 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: NAIC 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
Disclaimer of Control: Allowed at the Office's discretion

 

After Licensure:  Any change in officer/director requires NAIC 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: NAIC Biographical Affidavit and Independent Third-Party Verification
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification
Domestic Corporate Amendment: NAIC Biographical Affidavit
Disclaimer of Control: Not Allowed

Contact state for requirements.

Biographical Affidavit: 
RegServices@oci.ga.gov

Third-Party Verification Reports:
RegServices@oci.ga.gov and 
pcoppel@oci.ga.gov

HI

Contact state for requirements. 

Contact state for requirements. Contact state.
ID

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification
Form A: Contact State
Domestic Corporate Amendment: Contact State
Disclaimer of Control: Not Allowed

After Licensure: NAIC 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 NAIC Biographical Affidavits with original signatures and the bios shall be notarized required for all domestic companies’ Officers and Directors. Independent Third-Party Verification Reports are required for all Officers and Directors. 
Redomestication Application: Current Version of the NAIC Biographical Affidavits with original signatures and the bios shall be notarized required for all domestic companies’ Officers and Directors.  Independent Third-Party Verification Reports are required for all Officers and Directors. 
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Not Allowed

After Licensure: Current Version of the NAIC 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: 
Property/Casualty Companies:
Tammy Jones 
tammy.jones@illinois.gov

Life, Accident & Health Companies:
Pearl Stanulis
pearl.stanulis@illinois.gov

Third-Party Verification Reports:
Mail to:
Illinois Department of Insurance            Attn:  Corporate Regulation Section  
320 West Washington Street– 4th Floor
Springfield, IL 62767

IN

Indiana Biographical Affidavits with electronic signature which complies with the electronic transaction act (IETA)(IC 26-2-8-108) and Independent Third-Party Verification  required for all domestic companies

Note: Electronic signatures from commercially available software, such as Docusign or Esign, are acceptable. “Check the Box” signatures or “Rubber Stamp” signatures Do Not Comply.

Disclaimer of Control: Allowed

Electronically signed Indiana Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel.
Disclaimer of Control: Allowed

Note: Electronic signatures from commercially available software, such as Docusign or Esign, are acceptable. “Check the Box” signatures or “Rubber Stamp” signatures Do Not Comply.

Application Submissions
Primary, Redomestication
Connie Wright
(317) 232-1994
Cowright1@idoi.in.gov

Form A, Corporate Amendment
Annette Gunter
(317) 232-2428
agunter@idoi.in.gov

Updates
Heather Brewer
(317) 232-2390
hbrewer@idoi.in.gov

IA

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification
Redomestication Application: Contact Iowa Insurance Division regarding Biographical Affidavits
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: Biographical Affidavits are required for changes in Officers, 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: NAIC Biographical Affidavit and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification.
Domestic Corporate Amendment: None
Disclaimer of Control: Contact state
After Licensure: NAIC 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:
Tish Becker
Kansas Insurance Department
tish.becker@ks.gov
785-296-7816

Third-party background reports should be sent electronically (via e-mail) to the following state contact:
Tish Becker
tish.becker@ks.gov

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 http://www.ldi.la.gov/industry/company-licensing/application-forms/ucaa….
Redomestication Application: Same as Primary Application
Form A: Same as Primary Application
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

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 http://www.ldi.la.gov/industry/company-licensing/application-forms/ucaa….

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: NAIC Biographical Affidavits and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavits and Independent Third-Party Verification.
Form A: NAIC Biographical Affidavits and Independent Third-Party Verification.
Domestic Corporate Amendment: NAIC Biographical Affidavits and Independent Third-Party Verification.
Disclaimer of Control: Not Allowed

After Licensure: NAIC 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: NAIC Biographical Affidavit dated within 6 months of filing application and Independent Third-Party Verification Report required
Redomestication Application: NAIC Biographical Affidavit dated within 6 months of filing application and Independent Third-Party Verification Report required
Form A: NAIC Biographical Affidavit dated within 6 months of filing and Independent Third-Party Verification Report required for the new UCP (those with a greater than 10% ownership) and any proposed officer or director of the domestic insurer. 
Domestic Corporate Amendment: not required
Disclaimer of Control: not required

After Licensure: NAIC 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: NAIC Biographical Affidavit and Independent Third-Party Verifications are required for Primary Applications. Signatures must be original, and dated within 6 months of application.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verifications are required. Signatures must be original, and dated within 6 months of application. 
Form A: NAIC Biographical Affidavit and Independent Third-Party Verifications are required. Signatures must be original, and dated within 6 months of application. 
Domestic Corporate Amendment: Articles/Bylaws - not needed.
Disclaimer of Control: Not Allowed

After Licensure: Any new individual on the Jurat page must submit an NAIC Biographical Affidavit dated within 6 months, original or digital signatures are accepted.

NAIC Biographical Affidavit: 
Domestic companies should submit to insurance.commerce@state.mn.us within 60 days of the change. 
MS

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verifications are required for Primary Applications. Signatures must be original.
Redomestication Application: NAIC Biographical Affidavit
Form A: NAIC Biographical Affidavit and Independent Third-Party Verifications are required for Primary Applications. Signatures must be original.
Domestic Corporate Amendment: NAIC Biographical Affidavit
Disclaimer of Control: Not Allowed

Notification and a NAIC 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:
Electronic Method Preferred: Email: filings@mid.ms.gov or Chad.Bridges@mid.ms.gov

MO

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification.
Domestic Corporate Amendment: Depends on the corporate amendment type
Disclaimer of Control: Allowed, but must be submitted as a separate filing for consideration

 

Biographical Affidavit: 
InsuranceSolvency@insurance.mo.gov
(573)526-4877

Third-Party Verification Reports:
Third party verification reports should be sent in a secure fashion.  We prefer to establish box accounts where the vendors can upload the reports.  Each box account is specific to the vendor.  Contact our Division at InsuranceSolvency@insurance.mo.gov to set up an account.    

MT

Primary Application: NAIC Biographical Affidavit
Redomestication Application: Contact state
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel.

Biographical Affidavit and Third-Party Verification Reports:
Tavin Mogus
tmogus@mt.gov
406-444-3496

NE

Primary Application: UCAA biographical affidavit and 3rd party verifications, no fingerprints
Redomestication Application: NAIC biographical affidavit and 3rd party verifications, no fingerprints
Form A: NAIC biographical affidavit and 3rd party verifications, no fingerprints
Domestic Corporate Amendment: It will vary depending on amendment, check with the DOI
Disclaimer of Control: Contact state

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: NAIC Biographical Affidavit
Redomestication Application: Contact state
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC 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 - NAIC Biographical Affidavit and criminal history record check by the New Jersey State Police. Link: https://www.njportal.com/NJSP/CriminalRecords/Default.aspx. Once at the website enter Originating Agency Identifier (ORI) #: NJDINS11X. Primary L&H: NAIC Biographical Affidavit and Independent Third-Party Verification. Contact the Department for state specific information (Solvency Regulation 609-292-7272).
Redomestication Application: NAIC Biographical Affidavit and criminal history record check by the New Jersey State Police. See link above.
Form A: NAIC Biographical Affidavit, Independent Third Party Verification (with NAIC approved vendor), and criminal history record check by the New Jersey State Police. Submit inquiries pertaining to the filing of a Form A to: NJFormAfilings@dobi.nj.gov
Domestic Corporate Amendment: Same as Primary App.  Required for new officers/directors or individuals holding a controlling interest in insurer.
Disclaimer of Control: Separate filing required

After Licensure P&C: NAIC Biographical Affidavit and criminal history record check by the New Jersey State Police.

After Licensure L&H: NAIC Biographical Affidavit, and Independent Third-Party Verification.

Biographical Affidavit and Third-Party Verification Reports:
UCAANotifications@dobi.nj.gov

NM

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification.
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Not Allowed

After Licensure: NAIC 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: NAIC Biographical Affidavit AND Independent Third-Party Verification 
Redomestication Application: NAIC Biographical Affidavit AND Independent Third-Party Verification 
Form A: NAIC Biographical Affidavit AND Independent Third-Party Verification 
Domestic Corporate Amendment: not required  

Disclaimer of Control: Contact state

After Licensure: NAIC 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:  

Third party verification reports should be sent directly to NY DFS by the third-party vendor using the DFS Portal (an account is not required). A copy of the biographical affidavit is required to be included with the report.

State Email Contacts:  
Property and Casualty 
Health  
Life 

NC

Contact state for requirements.

Contact state for requirements. Contact sate.
ND

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification
Domestic Corporate Amendment: N/A
Disclaimer of Control: Not Allowed

After Licensure: NAIC Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel.

Biographical Affidavit: 
​​​Matt Fischer
mattfischer@nd.gov 
or
Nichole Feldman
nrfeldman@nd.gov

Third-Party Verification Reports:
colicexam@nd.gov

OH

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification
Redomestication Application: Contact state
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC 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: NAIC Biographical Affidavit
Redomestication Application: Contact state
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC 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: NAIC Biographical Affidavit and Independent Third-Party Verification
Redomestication Application: Contact state
Form A: Contact State
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC 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
Disclaimer of Control: Allowed

NAIC 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: NAIC Biographical Affidavit and Independent Third-Party Verification are required.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification are required.
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification are required.
Domestic Corporate Amendment: NAIC Biographical Affidavit and Independent Third-Party Verification are required.
Disclaimer of Control: Allowed

After Licensure: NAIC Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel.
Disclaimer of Control: Allowed

Biographical Affidavit and Third-Party Verification Reports:
Deonna G. Rogers
drogers@doi.sc.gov

SD

Primary Application: NAIC Biographical Affidavit
Redomestication Application: Contact state
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Contact state

After Licensure: NAIC Biographical Affidavits are required for changes in Officers, Directors, or Key Managerial Personnel

Biographical Affidavit:
Domestics should contact their individual financial analyst or Johanna.Nickelson@state.sd.us

Third Party Verification Reports:
Johanna Nickelson
Assistant Director Company Solvency and Licensing
SD Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501

TN

Primary Application: Biographical affidavits and third-party background checks of board members and officers.
Redomestication Application: Biographical affidavits and third-party background checks of board members and officers.
Form A: Biographical affidavits and third-party background checks of board members and officers.
Domestic Corporate Amendment: Biographical affidavits and third-party background checks of new board members and officers.
Disclaimer of Control: Contact state

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: NAIC 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
Company’s ultimate controlling person. We DO NOT require biographical affidavits, Identogo Fingerprint receipts, and Third-Party verifications for Vice Presidents or Assistant-officers. 
Redomestication Application: Same requirements as the Primary application
Form A: Fingerprint Requirements and Instructions found at https://www.tdi.texas.gov/agent/fingerprint-instructions.html
Domestic Corporate Amendment: Only if officer/director changes have been made
Disclaimer of Control: Not Allowed

After Licensure: NAIC 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:
CLRBioUpdate@tdi.texas.gov

*UT

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC 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: NAIC Biographical Affidavit & Third-Party Verification is required.
Redomestication Application: NAIC Biographical Affidavit & Third-Party Verification is required.
Form A: NAIC Biographical Affidavit & Third-Party Verification is required.
Domestic Corporate Amendment: NAIC Biographical Affidavit maybe required
Disclaimer of Control: Not Allowed

After Licensure Updates: NAIC Biographical Affidavit; Independent Third-Party Verification may be required.

Biographical Affidavit: 
(802)-828-2470
or
dfr.complic@vermont.gov

Third-Party Verification Reports:
Contact state if requested

VA

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Redomestication Application: Contact state
Form A: Contact state
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC 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: NAIC Biographical Affidavit and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification as required by UCAA requirements
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification of acquiring persons
Domestic Corporate Amendment: NAIC Biographical Affidavit and Independent Third-Party Verification.
Disclaimer of Control: Allowed

After Licensure: NAIC 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:
clc@oic.wa.gov

WV

Primary Application: NAIC Biographical Affidavit is required.
Redomestication Application: NAIC Biographical Affidavit is required if there are changes.
Form A: NAIC Biographical Affidavit is required if there are changes.
Domestic Corporate Amendment: NAIC Biographical Affidavit is required if there are changes.
Disclaimer of Control: Not Allowed

After Licensure: NAIC Biographical Affidavit is required for new officers and/or directors AND amendments to officers and/or directors.

WV Offices of the Insurance Commissioner
Financial Conditions Division
(304) 558-2100
oicfinancialconditions@wv.gov

*Do not email Bio's to the above email. They can be viewed in UCAA or sent to:

WV Offices of the Insurance Commissioner
Financial Conditions Division
PO Box 50540
Charleston, WV  25305-0540

Third-Party Verification Reports:
Third-Party Verification Reports are required.

WI

Primary Application: NAIC Biographical Affidavit required (but not fingerprints or Independent Third-Party Verifications)
Redomestication Application: NAIC Biographical Affidavit required (but not fingerprints or Independent Third-Party Verifications)
Form A: NAIC Biographical Affidavit required (but not fingerprints or Independent Third-Party Verifications)
Domestic Corporate Amendment: Contact state
Disclaimer of Control: Allowed

After Licensure: NAIC Biographical Affidavit required for any changes in Directors, Officers or Key Managers (but not fingerprint or Independent Third-Party Verifications). 

Biographical Affidavit: 
Suzanne Vinmans
suzanne.vinmans@wisconsin.gov
or
Mark McNabb
mark.mcnabb@wisconsin.gov
or
Christopher Martin
christopherj.martin@wisconsin.gov

Third-Party Verification Reports:
Contact the state if requested

WY

Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Redomestication Application: NAIC Biographical Affidavit and Independent Third-Party Verification.
Form A: NAIC Biographical Affidavit and Independent Third-Party Verification.
Domestic Corporate Amendment: NAIC Biographical Affidavit and Independent Third-Party Verification.
Disclaimer of Control: Not Allowed

After Licensure: NAIC 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