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WITHDRAWAL REQUIREMENTS
WITHDRAWAL REQUIREMENTS

FOREIGN INSURANCE COMPANY WITHDRAWAL/COMPLETE SURRENDER OF CERTIFICATE OF AUTHORITY APPLICATION

Updates to the information will be noted with a “ * ” next to the state name and edits will be italicized and bolded.
Last Updated: 07/22/2020

State Fee Requirement Contact
AL  
  • Surrender current Alabama Certificate of Authority
  • UCAA Form 17, along with attachments which are required based
    on the responses to the Form, must be filed.

Alabama Insurance Department
P. O. Box 303351
Montgomery, AL  36130

AK  
  • Company must be currently compliant.
  • Must fulfill all current, and arrange for future, necessitates (taxes due, etc.)
  • Original Alaska Certificate of Authority
  • AS 21.09.245 and 3 AAC 31.050

Division of Insurance
State of Alaska
P O Box 110805
Juneau, AK 99811-0805

*AZ  
  • Provide a statement of the insurer’s financial condition as of a date within 60 days of the
    filing date of the request for termination that includes a written statement, signed by two officers
    of the insurer as authorized on the jurat page of the insurer’s most recent annual statement,
    verifying that the statement of financial condition reflects the insurer’s financial position as of the
    date signed.
  • Provide a plan of extinguishment of the insurer’s outstanding liabilities that satisfies the requirements
    of AACR20-6-303(C) OR a sworn affidavit stating that the insurer has no outstanding liabilities to
    policyholders or claimants under AAC R20-6-303 (C).
  • Arizona Administrative Code R20-6-303

Cary W. Cook
Chief Financial Compliance Officer
Arizona Dept. of Insurance
Financial Affairs Division
100 N. 15th Ave., Suite 261
Phoenix, AZ 85007-2630
(602) 364-3986
ccook@azinsurance.gov

AR  

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
(501) 371-2820
Insurance.legal@arkansas.gov

CA  

California Insurance Code Sections 1070-1076.
Foreign withdrawal fee: $1,410

 
CO None Summary of the company’s plan to transfer or run-off any existing business in the lines to be deleted. 

Cindy Hathaway
Director, Corporate Affairs
(303) 894-7836
Cindy.Hathaway@state.co.us

CT  
  • All outstanding losses and liabilities have been paid in the State of Connecticut.
  • Board of Directors Resolution and Shareholder Resolution.
  • Completed NAIC UCAA Statement of Withdrawal (Form 17)

Company Licensing Section
(860) 297-3814
ctinsdept.financial@po.state.ct.us

DE  
  • Provide a statement notarized by an officer of the company that there are no outstanding policies,
    claims and liabilities.
  • Return original Certificate of Authority.

Delaware Department of Insurance
Attn. B.E.R.G
1351 West North Street, Suite 101
Dover, DE 19904
(302) 674-7300 
berg@delaware.gov

DC  
  • Return Original Certificate of Authority.
  • Provide a written statement that the insurer is surrendering the license.                                                                                              

Denise Parker
Company Licensing Specialist
DC Department of Insurance & Securities Regulation
1050 First St., NE, Suite 801
Washington, DC 20002
(202) 442-7815
denise.parker@dc.gov

FL None
  • 90 days written notice of reason for surrendering. Refer to Section 624.430, Florida Statutes, and
    Rule 690-141.020, Florida Administrative Code for the required format for the Notice and its contents.
  • Return original Certificate of Authority.

For all Life & Health Companies:
Joe Erhart
Applications Coordinator – L&H
(850) 413-5066
joe.erhart@floir.com

For all Property & Casualty Companies:
Patty Spudeck
Applications Coordinator – P&C
(850) 413-2578
patty.spudeck@floir.com 

GA    

Kimnese Abdul-Salaam
kabdul-salaam@oci.ga.gov

*HI None

Return of the company’s original Hawaii Certificate of Authority or an affidavit of loss (Form 15) notarized
and signed by an officer of the company. 

Comply with the following Hawaii Revised Statute (HRS) sections:

HRS §431:3-215:  Withdrawal from State; obligation
HRS §431P-17:  Additional notice requirement

Andrew Chow
Insurance Examiner
State of Hawaii, Insurance Division
P.O. Box 3614
Honolulu, HI 96811-3614
Tel. (808) 586-3874
Fax: (808) 586-3873
achow@dcca.hawaii.gov

ID None
  • Form 17 or letter requesting to withdraw.
  • Return Original Certificate of Authority.

Corporate Amendment Apps:
Michele Munoz
Technical Records Specialist
Idaho Dept. of Insurance
700 W. State Street, 3rd Floor
PO Box 83720
Boise, ID 83720-0043
Tel: (208) 334-4311
michele.munoz@doi.idaho.gov 

IL  
  • Surrender the Original Certificate of Authority
    Sec. 118 Code (215 IICS 5/118)
 
*IN  
  • Letter requesting withdrawal and completion of Form 17, Statement of Withdrawal
  • Return of the original Indiana Certificate of Authority for cancellation
    *25 Filing Fee

Annette Gunter
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, IN 46204-2787
(317) 232-2428
agunter@idoi.in.gov

IA None

Letter requesting withdrawal and completion of Form 17, Statement of Withdrawal.

Return of the current Iowa Certificate of Authority for cancellation.

Nancy Ferguson, Examiner
Iowa Insurance Division
Two Ruan Center
601 Locust, 4th Floor
Des Moines, IA 50309-3738
(515) 281-4423 nancy.ferguson@iid.iowa.gov

*KS  

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.

Return Original Certificate of Authority.

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  

A letter stating the Co. has no business in KY.
Return of Original Certificate of Authority.
Company must also file Articles of Dissolution with the KY Secretary of State.

KRS 304.3-180

Kentucky Department of Insurance
P. O. Box 517
Frankfort, KY 40602-0517
Gina Metts
Financial Standards and Examination Division
(502) 782-5298
gina.metts@ky.gov

LA None La. R.S. 22:341

Mike Boutwell
P.O. Box 94214
Baton Rouge, LA 70804-9214
(225) 342-0800
mboutwell@ldi.la.gov

Tangela Byrd
(225) 342-5972
tbyrd@ldi.la.gov

ME  

24-A M.R.S.A.§ 415-A: Withdrawal plan must be submitted for approval at least 60 days prior to the
proposed date of withdrawal. See section 415-A and Me. Dep’t of Prof. & Fin. Reg., 02-031 CMR 400
for plan requirements.

The original Certificate of Authority must be returned.

Lauri Cooper
Maine Bureau of Insurance
34 State House Station
Augusta, ME 04333-0034
(207) 624-8464
laurelyn.s.cooper@maine.gov

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.

Victoria Claros
Director of Company Licensing
Maryland Insurance Administration
200 St. Paul Place, Suite 2700
Baltimore, MD 21201
(410) 468-2134
Victoria.claros@maryland.gov

MA  

M.G.L.c.175,§44 is for MA Domestic Insurers.

Foreign Insurers need to demonstrate that there is a plan in place that has been approved that protects
MA policyholders with current or future claims.

MA Division of Insurance
John Turchi
Financial and Market Regulation
1000 Washington Street, Suite 810
Boston, MA 02118-6200
(617) 521-7701
john.turchi@state.ma.us

MI  

In addition to the UCAA corporate amendments application, an affidavit signed by an actuary must be
included indicating that the Company does not have any outstanding Michigan business to secure.  

Return of original Certificate of Authority.

Linda L. Martin
517-284-8756
martinl@michigan.gov

*MN  

If the Company hasn’t written in MN: the Company is automatically allowed to withdrawal.

60A.052, subd. 4a

The Department requires a letter, signed by the President of the Company, to be sent to us stating the
number and amount of outstanding claims and number of policies in-force in the State of Minnesota.  The
letter must also state that the Company will pay any and all outstanding desk audit fees charged to the
Company at the time of the withdrawal.  The Department will review the information and may issue an
Order permitting such withdrawal from Minnesota.  Note under Minn. Stat. 60A.052, Subd. 4a, all direct
liability to Minnesota policyholders and obligees have to be assumed by another insurer before a company
is allowed to withdraw.

Judy Johnson
Phone: (651) 539-1760
Fax: (651) 539-1550
judith.johnson@state.mn.us

Contact – Kathleen Orth
Chief Examiner/Solvency Manager
MN Dept. of Commerce
85 7th Place East, Suite 280
St. Paul, MN  55101-2198

MS  

Surrender current Certificate of Authority

Form 12 would not be required to be filed by an unlicensed insurer.

All taxes, fees & filings due to MS Department of Revenue, MS State Rating Bureau, MS Workers’ Comp.
Commission & MS Insurance Department have been made.

If business has been transferred to another company prior to the filing of the Form 17, prior notice of the
reinsurance transaction and approval of the policyholder notification would be required.

Original signatures are needed on Form 17.

Nancy Cross,
Director Statutory Compliance
P.O. Box 79
Jackson, MS 39205
601.359.3571
Nancy.cross@mid.ms.gov

MO  

375.871.1 RSMO
Copy of Board of Director’s Resolution regarding withdrawal from the State. 

Cindy Monroe, Admissions Specialist
(573) 751-4362

MT  

Ensure that there are no remaining liabilities to MT policyholders or claimants, and obtain the return
of the original MT Certificate of Authority.

Michelle Scaccia
Montana Insurance Department
840 Helena Ave.
Helena, MT 59601

NE  
  • The company must have a procedure in place to handle outstanding claims and policyholders for any
    in-force business.
  • Surrender current Certificate of Authority.

Kristy Hadden, Company Administrator
(402) 471-0373
Kristy.hadden@nebraska.gov

Lori Bruss, Staff Assistant II
Examination Division
(402) 471-4045
lori.bruss@nebraska.gov

NV  

Foreign RRG –
Surrender original Nevada Certificate of Authority or submit a Form 15 Affidavit of Loss, signed by
President of company.
Contact Kathy Kelley, Administrative Assistant, to obtain a Foreign RRG Withdrawal Requirements
Checklist

Foreign Insurance Company –
Surrender original Nevada Certificate of Authority or submit a Form 15 Affidavit of Loss, signed by
President of company.
Submit Form 17 Statement of Withdrawal to Robert Gallegos, Administrative Assistant  

Nevada Division of Insurance
Kathy Kelley, C&F
1818 E. College Parkway, Suite 103
Carson City, NV  89706
kkelley@doi.nv.gov
(775) 687-0753

Nevada Division of Insurance
Denise Costello
1818 E. College Parkway, Suite 103
Carson City, NV  89706
dcostello@doi.nv.gov
(775) 687-0752

*NH $25 and subject to retaliatory fees.

NH Application for Amendment Form

Original Certificate of Compliance from state of domicile

Return of NH current original Certificate of Authority

Lisa Cotter, Financial Regulation Division
NH Insurance Dept.
21 S Fruit St., Ste 14
Concord, NH 03301
Tele (603) 271-2528
Fax  (603) 271-7029
Lisa.Cotter@ins.nh.gov

NJ  

If a company has no open liabilities in New Jersey for the lines it wishes to delete, it may submit a
certification to that effect from its Board of Directors to:
New Jersey Department of Banking and Insurance
Solvency Regulation - Kwame Asare
P.O. Box 325
Trenton, NJ 08625

If a company has open liabilities it must submit a withdrawal plan pursuant to N.J.A.C. 11:2-29.1 et seq.
to the address noted above.

 
NM No Fee

Surrender Certificate of Authority.

NAIC UCAA Statement of Withdrawal Form 17

Victoria Baca
(505) 827-4438

Ursula Almada
(505) 827-4524

Office of Superintendent of Insurance
PO Box 1689
Santa Fe, NM 87504-1689

*NY   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
One Commerce Plaza
Albany, NY 12257
(518) 474-6623

And another original to the applicable bureau:Property Bureau
Eileen Fox, Assistant Chief Examiner
New York State Department of Financial Services
One State Street
New York, NY 10004
(212) 480-5565
eileen.fox@dfs.ny.gov

Life Bureau
Victor Agbu, Assistant Chief Examiner

New York State Department of Financial Services
One State Street
New York, NY 10004
(212) 480-5040
victor.agbu@dfs.ny.gov

Health Bureau
Warren Youngs, Supervising Examiner
New York State Department of Financial Services
One State Street
New York, NY 10004
(212) 480-5045 warren.youngs@dfs.ny.gov

Tom Dudek, Supervising Examiner
New York State Department of Financial Services
One State Street
New York, NY 10004
(212) 480-5037
Thomas.Dudek@dfs.ny.gov

NC None

Cease writing business in NC.
Provide actuarial Certification regarding outstanding policyholders obligations. 

Brenda Young, Corp.Records Admin.
1203 Mail Service Center
Raleigh, NC 27699-1203
(919) 807-6164
byoung@ncdoi.gov

ND  

For Property & Casualty products pursuant to ND.
N.D.C.C. Section 26.1-25-04.4

See http://www.nd.gov/ndins/companies/companylicensing/voluntarywithdrawal/ for voluntary withdrawal
guidelines for all companies.

Company Licensing and Examinations Divisions
ND Insurance Department
600 East Boulevard Avenue, Dept 401
Bismarck, ND 58505-0320
(701) 328-2440
colicexam@nd.gov

OH None In order to surrender its COA, a company must provide notice to policyholders through publication and then
make application to the Department to surrender.  Companies intending to surrender should contact the
Department for guidance on how to proceed.

Cameron Piatt
Assistant Chief-Taxes, Admissions and Foreign Analysis
Office of Risk Assessment
(614) 728-1074
Cameron.piatt@insurance.ohio.gov

*OK  

Return Oklahoma Certificate of Authority, completed UCAA Form 17 Statement of Withdrawal and UCAA
Form 16a (if applicable).

Please assure rate and form filings have been completed electronically through SERFF. Call our Rate &
Form Compliance Division at 405-521-3681 should you have any questions regarding rate and form filings.
Pursuant to Oklahoma Regulation 365:15-1-18/Oklahoma Regulation 365: 15-7-31. Any insurer desiring
to withdraw from the state or discontinue the writing of certain classes of insurance in this state shall give
ninety (90) days’ notice in writing to the Insurance Department and shall state in writing its reasons for
such action.

The insurer shall also provide the following information: 
(1) The number of policyholders effected; 
(2) The number of insurance agents effected; 
(3) The date the insurer will cease writing new business; 
(4) The date the insurer will start non-renewing insurance policies; 
(5) The date the insurer will transfer policyholders; 
(6) Whether the insurer has made arrangements with another insurer to pick up the renewals; 
(7) The lines of insurance on which the insurer plans to concentrate; and 
(8) Whether the insurer anticipates re-entering the market.

Michael Parrott
Financial Analyst
Oklahoma Insurance Department
400 NE 50th Street
Oklahoma City, OK 73105

(918) 295-3711
ucaa@oid.ok.gov

OR None

Submit an affidavit, which indicates the company, has no outstanding claims, liabilities or in-force business
in the state of Oregon and if any should arise, the company will take full responsibility. Affidavit must be
signed by an officer of the company. Submit current original Certificate of Compliance from state of domicile.
Return original Certificate of Authority.

ORS 731-512

Lauren Bodine, Financial Filings Coordinator
Insurance Division-4
Company Regulation Section
350 Winter St., NE Room 440
Salem, OR 97301-3883
(503) 947-7225
Lauren.N.Bodine@oregon.gov

PA  

Requirements for Plan of Withdrawal see:  http://www.insurance.pa.gov/Companies/ChangeProfile/Documents/Insurance%20Department%20Plan
%20of%20Withdrawal%20Transition.pdf

and

Surrender Certificate of Authority see:  http://www.insurance.pa.gov/Companies/ChangeProfile/Documents/foreign%20surrender%20COA%
20requirements%202017.pdf

Chief, Company Licensing Division
PA Insurance Department
1345 Strawberry Square
Harrisburg, PA 17120
(717) 787-2735
ra-in-companylicense@pa.gov

PR  

Circular letter No. E-10-1395-95 found on our website.

Companies intending to surrender should contact the Department for guidance on how to proceed.

Mrs. Glorimar Santiago
Interim Director
Admissions and Financial Analysis Division
(787)304-441
gsantiago@ocs.gobierno.pr

RI   An insurance company may apply for permission to surrender or not renew its license for a line of insurance pursuant to R.I. Ins. Div. Reg. 58 Debra Almeida
Rhode Island Insurance Division
1511 Pontiac Avenue, Bldg 69-2
Cranston, RI 02920
(401) 462-9542
debra.almeida@dbr.ri.gov
SC   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.

Lee Hill
Chief Financial Analyst
P.O. Box 100105
Columbia, SC 29202-3105
(803) 737-6199
lhill@doi.sc.gov

*SD  

Submit written letter of request to withdraw, signed by an officer.
Indicate: No policies currently in force in SD & no outstanding claims or liabilities.
Please state: No business done in calendar year or if Yes premiums were received in calendar year. If Yes a "Final Premium Tax Return must be submitted along with taxes.
Mark as Final Return.
Return Original Certificate of Authority

Patsy Madsen, Company Licensing Specialist
SD Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501
(605) 773-3563
patsy.madsen@state.sd.us

TN  

Surrender of C of A or Affidavit of Lost C of A.
A statement advising of the resolution of the company’s current business in TN.

Phil Adams, Analyst
(615) 741-1670
phil.adams@tn.gov

*TX No filing fee. Cancellation of license filings only, not market withdrawal plan filing as required in Texas Insurance Code (TIC) 827 and 28 Texas Administrative Code (TAC) §§7.1801-7.1808 provides for a company to withdraw with PRIOR approval of the Commissioner of Insurance. See webpage for withdrawal requirements: https://www.tdi.texas.gov/forms/fincolicense/fin349withdraw.pdf.

Company Licensing and Registration
General Inquiries:
CompanyLicense@tdi.texas.gov

Electronic Filing via UCAA or CLRFilings@tdi.texas.gov

UT Withdrawal Fee, if required by UCA § 31A-4-115(2) -

UCA § 31A-4-115

Statutes, Administrative Rules, and forms are available at https://insurance.utah.gov

Dava Neal
Company Licensing Specialist
(801) 538-3812
dneal@utah.gov

VT $25.00 or retaliatory amount A foreign or alien company, upon withdrawing from the state of Vermont, shall pay to the Commissioner $25.00 for the filing of its final financial statement.  8 V.S.A § 3561

Company Licensing
(802) 828-2470
dfr.complic@vermont.gov

VA None A foreign insurance company/corporation is referred to the Office of the Clerk of the State Corporation Commission to surrender its general certificate of authority. An officer of the company must submit an affidavit requesting to surrender its license and the company is reviewed for direct business in VA.

Gayle Henderson, Office Supervisor
VA SCC/Bureau of Insurance
P.O. Box 1157
Richmond, VA 23218
(804) 371-9869
gayle.henderson@scc.virginia.gov

WA  

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
Washington State Office of the
Insurance Commissioner
PO Box 40255
Olympia, WA 98504-0255
(360) 725-7200
csf@oic.wa.gov

WV  

http://www.wvinsurance.gov/company/

45 days prior, the company is required to submit a formal plan of withdrawal.

WV Offices of the Insurance Commissioner
Financial Conditions Division
PO Box 50540
Charleston, WV  25305-0540
(304) 558-2100
oicfinancialconditions@wv.gov

WI  

Any transfer of business or reinsurance other than in the normal and usual course of business must be reported to the Office not less than 30 days in advance of the proposed effective date, and is subject to disapproval under s. 618.32, Wis. Stat.

If applying for a release from regulation, the company must comply with s. 618.36, Wis. Stat.

Michael Mancusi-Ungaro
Company Licensing Specialist
Bureau of Financial Analysis and Examinations
Office of the Commissioner of Insurance
(608) 267-4555 Michael.MancusiUngaro@wisconsin.gov

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)

Samantha Sullivant
Wyoming Ins. Dept.
106 East 6th Avenue
Cheyenne, WY 82002
(307) 777-7318
Samantha.sullivant@wyo.gov

G. Douglas Melvin, Chief Examiner
(307) 777-5619
doug.melvin@wyo.gov

 

 

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