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 | Fee | Requirement | Contact |
|---|---|---|---|
| AL | No Fee | Signed and Notarized Affidavit from Company President stating that all claims and/or liabilities related to claims have been paid. Original COA must be returned. |
Hamp Russell |
| *AK | N/A | Completion of Voluntary Surrender of Certificate of Authority (Form 08-290). Additional requirements in AS 21.10.135, AS 21.06.245, AS 21.69.648. |
Kevin Richard |
| AZ | None | Contact the Department for instructions. |
Cary W. Cook |
| AR | None |
Any insurer desiring to surrender its Certificate of Authority, withdraw from this state, or discontinue the writing of certain classes of insurance in this state shall give ninety (90) days notice in writing to the State Insurance Department and shall state in writing its reasons for such action. The commissioner may waive any part of the notice requirement. A.C.A §23-63-211(e) Return the original certificate of authority or an affidavit of loss notarized and signed by an officer of the company. Provide a notarized affidavit by an officer of the Company stating there are no outstanding policies, claims or known liabilities, and the Company has no premium tax (or other taxes) due in this state. Contact our Accounting Division for the filing of the proper “final” tax filings. Accounting Division (501-371-2605). |
Legal Division |
| CA | $ 1551 + $1000 publication fee |
State specific forms required - Withdrawal from California as an Insurer. |
CAB-SF-Intake@insurance.ca.gov |
| CO | None | Colorado Domestic Dissolution Guidelines | |
| CT | None |
Provide Form 16 along with verification that there are no active policies being written. |
Company Licensing Section |
| DE |
|
Delaware Department of Insurance |
|
| DC | No charge | Provide a written statement that the insurer is surrendering the license. Complete Corp Amendment Application Form 17. |
Kathy Alexander |
| *FL | Florida does not use this Form. | ||
| GA | Contact state | Letter requesting to withdraw, UCAA Form 16a, affidavit stating the company has no outstanding claims, suits, judgements or policies in the state of Georgia. |
Scott Sanders |
| HI | Contact state |
|
|
| ID | None | ||
| IL | None | 50 Illinois Administrative Code Part 2410. | Marcy.Savage@illinois.gov |
| IN | $25 |
IC 27-1-10. UCAA Form 16a. |
Annette Gunter |
| IA | Contact Iowa Insurance Division |
Contact Iowa Insurance Division. |
|
| KS | None |
Written statement from the Company stating that there is no existing or run-off business in KS and they do not intend to transact business in KS in the future. Uniform Certificate of Authority Application (UCAA) Statement of Withdrawal (UCAA Form 17). |
Tish Becker Director, Financial Surveillance Division Kansas Insurance Dept. Financial Surveillance Division 1300 SW Arrowhead Road Topeka, KS 66604 (785) 296-7816 Tish.becker@ks.gov |
| KY | Contact state | ||
| LA | None |
Application for Withdrawal found on website at www.ldi.la.gov. |
Tangela Byrd |
| ME | Contact state | ||
| MD | None |
Company will need to furnish the current Maryland original Certificate of Authority. In addition, a cover letter requesting the Company’s intention to withdraw, signed by an appropriate Corporate officer. |
Erin Nickles |
| MA | Contact state | ||
| MI | No fee |
Company should submit letter indicating its intent to surrender and return its original certificate of authority. |
Linda Martin |
| MN |
Contact state department for requirements at insurance.commerce@state.us. |
||
| MS |
Surrender Current Certificate of Authority. All taxes, fees & filings due to MS Department of Revenue, MS State Rating Bureau, MS Workers’ Comp. |
Chad Bridges |
|
| MO | $150 |
Requirements vary based on circumstances. |
Debbie Doggett |
| MT | Contact Montana CSI (406) 444-2040. | ||
| NE | $0 | Contact DOI. | Lindsy.crawford@nebraska.gov |
| NV | Contact state | ||
| NH | None |
If you have any liabilities they must be liquidated (or reinsured). File your articles of dissolution with the secretary of state. |
|
| NJ |
Orderly withdrawal of insurance business N.J.A.C. 11:2-29.1. Contact state for requirements. |
Nakia Reid, Manager (609) 940-7613 Nakia.Reid@dobi.nj.gov |
|
| NM | No Fee |
Surrender Certificate of Authority. NAIC UCAA Statement of Withdrawal Form 17. |
Victoria A. Baca Ursula Almada |
| NY | No Fee | For Life companies: submit Reg. 109 plan, certified board resolution, surrender license. Redomestication not allowed. | Life Contact Bradley Rice at OGC (bradley.rice@dfs.ny.gov). |
| NY | No Fee | Health: At least forty-five days prior to such proposed action insurer must submit a plan to protect the interests of people of NY for prior approval by the Superintendent pursuant to §1105 of the New York Insurance Law and Department Regulation 109 (11 NYCRR 88). |
We require that one original document be sent to: Office of General Counsel State of New York Department of Financial Services And another original to the applicable bureau: Health Bureau |
| NC | Contact state |
|
|
| ND | None |
See requirements on Department's website: https://www.insurance.nd.gov/companies/company-licensing/voluntary-with… |
Matt Fischer |
| OH | None | Company must file surrender of certificate of authority. |
Cameron Piatt |
| OK | Contact state | ||
| OR | Contact state |
|
|
| PA | N/A |
Please review guidance at: https://www.insurance.pa.gov/Companies/PlanOfWithdrawal/Pages/default.a…. |
|
| PR | No Fee |
Comply with Sections 29.480 to 29.540 of The Puerto Rico Insurance Code. |
Glorimar Santiago |
| RI | None | Request withdrawal. If approved, an Order is issued by the Superintendent of Insurance. | Debra Almeida Rhode Island Insurance Division 1511 Pontiac Avenue, Bldg 69-2 Cranston, RI 02920 (401) 462-9542 debra.almeida@dbr.ri.gov |
| SC | None |
A letter from the President or CEO stating there are no outstanding policies in-force and no outstanding liabilities or claims. Any policy in-force or unsatisfied claims outstanding in SC is provided via Reinsurance or Merger by a SC authorized entity. See Code Section 38-61-80 Withdrawing from the market. If the company has policies in force - The insurer would need to submit a SERFF filing formally withdrawing all forms, rates, and rules that have been approved by our Department, as they are no longer considered valid if they leave our state. |
Ryan Basnett
|
| SD | Contact state |
|
|
| TN |
$90 fee if planning to maintain the license |
If redomesticate out to other state:
The original Certificate of Authority issued to the Company by the TDCI, or an Affidavit of Lost or Misplaced Certificate. |
Trey Hancock |
| TX | $0 | UCAA Form 16A (Statement of Voluntary Dissolution form) and TX Form FIN351 (Voluntary Dissolution Checklist). |
Questions: |
| UT | Contact State | ||
| VT | $100 | Approval required by the Commissioner and once approved proof of redomestication is filed with the Secretary of State. 8 V.S.A. §3438 |
802-828-2470 or |
| VA | None | An officer of the company must submit an affidavit requesting to surrender its license and the company is reviewed for direct business in Virginia. |
Connie Duong |
| WA | No fee |
Return of the original Certificate of Authority. Documentation that supports the transfer or assumption of any in-force business. RCW 48.05.290 |
Company Supervision Division |
| WV | No fee |
https://www.wvinsurance.gov/company-definitions 45 days prior, the company is required to submit a formal plan of withdrawal. |
WV Offices of the Insurance Commissioner |
| WI | No fee | ||
| WY |
If leaving the health market, the company must comply with W.S. 26-15-121 and W.S. 26-19-305. If leaving the property & casualty market, the company must comply with Chapter 35 of the Wyoming Insurance Code. The company must return the original Certificate of Authority. W.S.26-3-113(c). |
G. Douglas Melvin, Chief Examiner |