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Notices & Forms - 2013 Annual/2014 Quarterly

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

201

HP-Annual Statement Blank .xls

Print Format: Select Entire Workbook, Legal size; Orientation: Portrait Must be submitted to the department on LEGAL size (8 1/2" X 14") paper

105

CA Affidavit - Declaration to Valuation of Property &
Securities/Verification
.xls

Print Format: Legal size; Orientation: Portrait

107

Authorization For Disclosure of Financial Records .xls

Print Format: Letter size; Orientation: Portrait

350

Instruction for Filing Management Discussion & Analysis .doc

Print Format: Letter size; Orientation: Portrait

201

HP-Quarterly Statement Blank.xls

Print Format: Select Entire Workbook, Legal size; Orientation: Portrait Must be submitted to the department on LEGAL size (8 1/2" X 14") paper

800

Report of Dividend- CA .xls

Bulletin 93-6

Print Format: Select Entire Workbook, Letter size; Orientation: Portrait

List of Home Protection Assigned CA Company Codes

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Updated Date: 05/15/14

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