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: 03/17/2025
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: Corporate Amendments Applications: Third-Party Verification Reports: |
| 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: Clara D. Mezza 501-683-3497 clara.mezza@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
|
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: Life, Accident & Health Companies: |
| 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. |
Electronically signed Indiana Biographical Affidavits are required for changes in Officers, Directors or Key Managerial Personnel. 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 Form A, Corporate Amendment Updates |
| *IA | Primary Application: NAIC Biographical Affidavit and Independent Third-Party Verification Redomestication Application: NAIC Biographical Affidavits and Independent Third-Party Verification Form A: NAIC Biographical Affidavit and Independent Third-Party Verification Domestic Corporate Amendment: Contact state Disclaimer of Control: Allowed |
After Licensure: NAIC Biographical Affidavits and Independent Third-Party verification are required for changes in Officer, 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: Third-party background reports should be sent electronically (via e-mail) to the following state contact: |
| 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: 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. |
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| 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:
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| *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: |
| 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: Third Party Verification Reports: |
| 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 *Do not email Bio's to the above email. They can be viewed in UCAA or sent to: WV Offices of the Insurance Commissioner Third-Party Verification Reports: |
| 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: Tracy McEwen tracy.mcewen1@wyo.gov |