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CA Department of Insurance
CA Department of Insurance
CA Department of Insurance

Life, Accident and Health, and Fraternal Insurers - Notices and Forms

Pursuant to California Code of Regulation ("CCR") 2308.1, the Insurance Commissioner ("Commissioner") designates the Internet-based financial filing system operated by the National Association of Insurance Commissioners ("NAIC") as the filing system to receive and store electronic filings of annual and quarterly financial statements from all admitted insurers.  A document is considered filed with the Commissioner when the filing is accepted by the NAIC.  Any financial statements, which are not required to be filed with the NAIC or required to be filed with the NAIC that is not accepted for filing by the NAIC, shall be filed directly with the California Department of Insurance ("CDI") via the Online Assistance System for Insurer Submittals ("OASIS").

As we are going paperless with the adoption of electronic financial filings, we are accepting electronic signature(s), verification, certification and notarization. The electronically submitted PDF file, to the NAIC and/or to the CDI, shall contain the required signature(s)/verification/certification/notarization. In addition, an admitted insurer shall maintain on file any statutorily required paper original of a properly executed document in accordance with the California Insurance Code (“CIC”) §730(f).

For non-electronic original signature(s), please use BLUE INK. All documents notarized in the state of California must comply with Section 8202 of the Government Code and Section 1185 of the Civil Code in reference to establishing an affiant’s identity.

Financial Filings Instructions:

Life, Accident and Health, and Fraternal Insurers Checklist.docx

Form
No.

Description

26

Disclosure of Material Transactions.xlsx

105

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

107

Authorization for Disclosure of Financial Records.docx

A110

Valuation of All Securities on Deposit with California.xlsx

151

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

152

Special California Schedule P ("SCASP").xlsx

 

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

470

Disclosure of Iran-Related Investments.xlsx

490

CA Trusteed Surplus Statement.xlsx

800

Report of Dividend - CA.xlsx

Bulletin 93-6

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

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Updated Date:

12/01/21

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