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CA Department of Insurance

Certification Request Form and Instructions

Please use the Certification Request Form to facilitate prompt handling of your request for certification of Financial Report of Examination, Annual Statements or Quarterly Statements.

All requests for certification must be sent to the Financial Records Unit in the Los Angeles office.  The Financial Records Unit will notify you when your certification request is completed and ready for pick-up.  We do not offer same day service on certification requests.  Allow approximately 2-4 weeks for processing of your request.  All copies produced for certification must be legible and complete.  To avoid delays, make sure you fill out the Certification Request Form correctly.  Please submit your completed form by mail or e-mail to the Financial Records Unit.

If there are any errors or discrepancies on the document(s) to be certified, you will be required to submit a new and correct document.  We do not certify documents that are, or contain, any of the following:

  1. Non-legible    
  2. Single page copied onto two pages.    
  3. Mended or attached to each other by tape, staples or any other adhesive to produce one page.

Once Financial Records Unit receives the corrected document, the certification will be processed. Please be advised that the Financial Records Unit does not certify Form B's or C's for anyone other than directly from the company, as these documents are confidential.

Payment of Fees (California Insurance Code § 12972 & 12973)

The current fee for each document certification request is $41.00, and $1.00 for the state seal. Additional certification for each document is $15.00, in addition to $1.00 for the seal. Be sure to add sales tax to your total cost. Do not include the postage cost when calculating your sales tax.  

Before we can process your request, we must receive payment in full. Please make your check, cashier check or money order payable to "California Department of Insurance". Do not send cash by mail and credit cards are not accepted. If you would like your documents to be mailed to you via overnight delivery, please submit your overnight air bill including your account number along with your enclosed check to our office. 

The Financial Records Unit will immediately call you and inform you of any calculation error(s) noted on your request form, and will either request additional fees or offer a refund on any overpayment. When your request is completed, the Financial Records Unit will contact you to pick up your certification(s) or will mail the certification(s) with your receipt to the address as shown on the request form, unless otherwise instructed. 

For questions or inquiries, please contact:  

Financial Records Unit
Phone: (213) 346-6423 E-mail:

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