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INSURERS: HOME PROTECTION - 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 filings, must be submitted electronically in PDF, MS-Excel or MS-Word formats utilizing the OASIS (Online Assistance System for Insurer 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 Unit
Phone: (213) 346-6423
E-mail: Financial_Records@insurance.ca.gov 

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

All filings must be submitted online before 12:00 midnight of the required due date. A required filing maybe subject to a late assessment fee, if submitted after the required filing date.

View Annual/Quarterly Statement Notices

Form No. Description Due Date Download Format
  Annual/Quarterly Statement and Others Requirements Checklist (doc - 104 kb)

 

 Print Format: Legal size; Orientation: Portrait
201 HP-Annual Statement Blank (xls - 1.15 Mb) 03-01-2012 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 - 721 kb) 03-01-2012 Print Format: Legal size; Orientation: Portrait

 

107

 

 Authorization For Disclosure of Financial Records(xls -  727 kb) 03-01-2012 Print Format: Letter size; Orientation: Portrait
350 Instruction for filling Management Discussion & Analysis
(doc - 730 kb)		 04-01-2012 Print Format: Letter size; Orientation: Portrait
201 HP-Quarterly Statement Blank (xls - 719 kb)

05-15-2012,
08-15-2012,
11-15-2012 

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

Report of Dividend- CA (xls - 86 Mb)

Bulletin 93-6

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

List of Assigned California Bar Code Numbers  

Updated Date: 1/24/2012

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