Last Updated: 02/10/2025
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 Richard.Russell@insurance.alabama.gov |
| *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 Kevin.Richardl@alaska.gov |
| AZ | None | Contact the Department for instructions. | Cary W. Cook Assistant Financial Compliance Officer cary.cook@difi.az.gov |
| 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) 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. |
Legal Division Insurance.legal@arkansas.gov |
| 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 | dora_ins_corporateaffairs@state.co.us |
| CT | None | Provide Form 16 along with verification that there are no active policies being written. | Company Licensing Section (860) 297-3800 cid.financial@ct.gov |
| DE |
|
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 | No charge | Provide a written statement that the insurer is surrendering the license. Complete Corp Amendment Application Form 17. | Kathy Alexander (202) 442-7819 kathy.alexander@dc.gov |
| *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 ssanders@oci.ga.gov |
| HI | Contact state | ||
| ID | None | doi.companyactivities@doi.idaho.gov | |
| IL | None | 50 Illinois Administrative Code Part 2410. | Marcy.Savage@illinois.gov |
| IN | $25 | IC 27-1-10. UCAA Form 16a. | Annette Gunter (317) 232-2428 agunter@idoi.in.gov |
| IA | Contact Iowa Insurance Division | Contact Iowa Insurance Division. | company.licensing@iid.iowa.gov |
| 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 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 | ||
| 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 Director of Company Licensing & Premium Tax Auditing Maryland Insurance Administration 200 St. Paul Place, Suite 2700 Baltimore, MD 21201 (410) 468-2451 (Office) erin.nickles@maryland.gov |
| MA | Contact state | ||
| MI | No fee | Company should submit letter indicating its intent to surrender and return its original certificate of authority. An affidavit signed by an actuary must be included indicating that the Company does not have any outstanding Michigan business to secure. |
Linda Martin Application Coordinator 517-284-8756 martinl@michigan.gov |
| 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. 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. Actuarial statement as to there being any outstanding liabilities. Draft Articles of Dissolution for approval. Board and Shareholders Resolutions approving the dissolution. |
Chad Bridges Chad.bridges@mid.ms.gov 601-359-2136 |
|
| MO | $150 | Requirements vary based on circumstances. | Danielle Smith Danielle.K.Smith@insurance.mo.gov 573-751-0474 |
| 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. | Linda.m.zalinskie@ins.nh.gov |
| 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 Chief Examiner & Director of Company Licensing & Examinations 701-328-2440 mattfischer@nd.gov |
| OH | None | Company must file surrender of certificate of authority. | Cameron Piatt Assistant Chief-Taxes, Admissions and Foreign Analysis Office of Risk Assessment (614) 728-1074 Cameron.piatt@insurance.ohio.gov |
| OK | Contact state | ||
| OR | Contact state | ||
| PA | N/A | Please review guidance at: https://www.insurance.pa.gov/Companies/PlanOfWithdrawal/Pages/default.a…. | RA-insresponse@pa.gov |
| PR | No Fee | Comply with Sections 29.480 to 29.540 of The Puerto Rico Insurance Code. | Glorimar Santiago gsantiago@ocs.pr.gov |
| 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 (Trey.Hancock@tn.gov) Hui Wattanaskolpant (Hui.Wattanaskolpant@tn.gov) |
| TX | $0 | UCAA Form 16A (Statement of Voluntary Dissolution form) and TX Form FIN351 (Voluntary Dissolution Checklist). | Questions: companylicense@tdi.texas.gov Filings - clrfilings@tdi.texas.gov |
| 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 DFR.CompLic@vermont.gov |
| 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 connie.duong@scc.virginia.gov |
| 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 Washington State Office of the Insurance Commissioner PO Box 40255 Olympia, WA 98504-0255 (360) 725-7200 clc@oic.wa.gov |
| 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 Financial Conditions Division PO Box 50540 Charleston, WV 25305-0540 (304) 558-2100 oicfinancialconditions@wv.gov |
| 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). | Tracy McEwen, Chief Examiner Wyoming Ins. Dept. 106 East 6th Avenue Cheyenne, WY 82002 (307) 777-5619 phone (307) 777-2446 fax tracy.mcewen1@wyo.gov |