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CA Department of Insurance

Notice to All Admitted Stock or Mutual, Fraternal, or Reciprocal Insurers

All insurers must complete an Annual Information Statement covering the period from the past calendar year (January 1 to December 31). Please complete one of the statements listed below that applies to your company.

In order to establish the company's continuing qualification to hold a California Certificate of Authority, the Annual Information Statement is due April 1 of the present calendar year. Please send the completed statement to the address below:

Department of Insurance
Corporate Affairs Bureau
45 Fremont Street, 24th Floor
San Francisco, CA 94105

Major changes within your Company during the past calendar year, such as those addressed in the Annual Information Statement, should have been reported to, and where necessary, prior approval obtained from the California Insurance Commissioner. If approval was not obtained, please provide that documentation with this Information Statement.

All questions must be answered. Indicate N/A if not applicable.

Please read the entire question carefully before responding. In several instances a "yes" response requires that you submit additional information/documentation.

California Certificate of Authority is continuous; no new renewal certificate will be issued. (California Insurance Code Section 701)

For further questions, please contact Pauline D'Andrea at (415) 538-4154.
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