Fraternal Notices and Forms

Return

Welcome to the California Department of Insurance

Insurers Overview / Insurers / Applications, Forms & Filings / Financial Filing Notices & Forms / Financial Filing Forms / Fraternal Notices and Forms

Insurers Overview

Insurers

Applications, Forms & Filings Bulletins & Notices Programs Officially Filed Reports of Examination

OASIS

Legal Information

Data & Reports

COIN

P&C Rate Filing

Health Insurance Rate Filings

Quick Links

-For Insurers-

INSURERS: FRATERNAL - NOTICES & FORMS - 2011 ANNUAL/2012 QUARTERLY

Annual/Quarterly Statement Financial Filing Requirements and Instructions
The following sections contain Filing Instructions and California specific forms for you to view and download. All required documents must be submitted electronically in PDF, MS-Excel or MS-Word formats, utilizing the (OASIS) Online Assistance System for Insurance Submittals. Additionally, please submit the original signature pages by the reporting deadline.

Mail to:

California Department of Insurance
Financial Analysis Division
300 South Spring Street, South Tower, 13th Floor
Los Angeles, CA 90013
Attention: Financial Records Unit

Questions or Inquiries Contact:
Financial Records
Phone: (213) 346-6423
E-mail: Financial_Records@insurance.ca.gov

Note: Please adjust your left and right margins to zero (0) before selecting the Print button in order to see all text.

All Filings must be submitted online before 12:00 midnight of the required due date.

View Annual/Quarterly Statement Notices

Form No.	Description	Due Date	Printing and Special Instructions
	Fraternal Checklist: Annual Statement and Other Requirements (doc - 251 kb)		Print Format: Legal size; Orientation: Portrait Note: If MS-Word-password screen pops up, please click on the [Read Only] button to open the file.
130	Authorization for Disclosure of Financial Records (xls - 727 kb)	03-01-2012	Print format: Letter size; Orientation: Portrait
135	Schedule-LS (4 pages) - For California domestic companies (xls - 1.45 MB)	03-01-2012	Print Format: Select entire workbook, Legal size; Orientation: Page 1: Portrait; Pages 2-3: Landscape
490	Trusteed Surplus (Must submit to both NAIC Trusteed Surplus Statement (42-kb) and CA-Department Trusteed Surplus Statement (43-kb)	03-01-2012	Print Format: Legal size; Orientation: Portrait

Updated Date: 5/16/2012
Back to Annual/Quarterly Statement Notices Menu