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CA Department of Insurance

Fraternal Societies - Notices & Forms

The following section contains filing instructions and forms for you to view and download. All filings, unless otherwise noted, must be submitted using the Online Assistance System for Insurer Submittals (OASIS).

For any document requiring original signatures, please mail the signature page(s) to:

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

For questions or inquiries, please contact:

Financial Records Unit
Phone: (213) 346-6423
E-mail: Financial_Records@insurance.ca.gov

Form No.

Description

Special Instructions

Annual Statement and Other Requirements
Checklist
.pdf

Print Format: Legal size; Orientation: Portrait

130

Authorization for Disclosure of Financial Records.xls

Print Format: Letter size; Orientation: Portrait

470

Disclosure of Iran-Related Investments .xls Print Format: Legal size; Orientation: Landscape

490

CA Trusteed Surplus Statement . xls

Print Format: Legal size; Orientation: Portrait

Back to Annual/Quarterly Statement Notices Menu

Updated Date: 05/13/14

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