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Property & Casualty Insurers - Notices and 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

 

List of Insurers or Reinsurers Authorized to Reinsure the Injury, Disablement, or Death Portions of Workers' Compensation Policies

 

 

Annual Statement and Other Requirements Checklist .pdf

Print Format: Legal size; Orientation: Portrait

26

Notice and Disclosure of Material Transactions .xls

Print Format: Letter size; Orientation: Portrait

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

A110

Valuation of All Securities on Deposit with California .xls

Print Format: Legal size; Orientation: Landscape (Except Certification page: Portrait) 

141

California Special Interrogatory for Mortgage Guaranty Insurers .xls

Print Format: Select Entire Workbook, Legal size; Orientation: Page 1&3-4: Portrait; Pages 2: Landscape

151

A & H Insurers/Reinsurers with Workers Compensation
Exposures
 
.xls

Print Format: Select Entire workbook, Legal size; Orientation: Portrait

152

Special California Schedule P ("SCASP") .xls

Print Format: Legal size; Orientation: Portrait

"SCASP" Part VII - Actuarial Certification Q&A's .doc

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

800

Report of Dividend - CA .xls

Bulletin 93-6

Print Format: Letter size; Orientation: Portrait

Back to Annual/Quarterly Statement Notices Menu

Updated Date: 01/22/14

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