Forms for Insurance Licensing
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| Title | Description |
|---|---|
| Form ADR (11/15/2022) | Adding a Designated Representative from the Business Entity’s License |
| Form Affiliation for DRLP | Acceptable Documents for DRLP Affiliation Evidences |
| Form DP for PBM (11/15/2022) | Designated Responsible Parties for Pharmacy Benefit Manager |
| Form DP for PE (11/15/2022) | Designated Responsible Parties for Portable Electronics |
| Form DP for SCP (11/15/2022) | Designated Responsible Parties for Service Contract Provider |
| Form DP for SSS (11/15/2022) | Designated Responsible Parties for Self-Service Storage |
| Form DP for VPPW (11/15/2022) | Designated Responsible Parties for Vehicle Protection Product Warrantor |
| Form for EIA | Emergency Independent Adjuster form – Must be submitted by the insurers, adjusting companies, or producers after the Commissioner issues a declaration |
| Form FRS (3/1/2021) | Service Contract Provider’s Financial Responsibility Statement |
| Form FSS (4/30/2019) | Vehicle Protection Product Warrantor’s Financial Security Statement |
| Form LC (11/15/2022) | Request for Letter of Certification / Letter of Clearance |
| Form List of RIs (11/15/2022) | Designated Responsible Parties for Reinsurance Intermediaries |
| Form List of SLBs (11/15/2022) | A List of licensed SLBs who is working under the business entity SLB |
| Form NTA (11/15/2022) | Notice of Name Change – Adding/Removing Trade Name – Adding Assumed Name |
| Form RC (11/15/2022) | Removing Classes of Insurance from a Hawaii Insurance License |
| Form RDR (11/15/2022) | Removing a Designated Representative from the Business Entity’s License |
| Form VS (11/15/2022) | Voluntary Surrender of License |
| Statement of MGA Appointment | The Insurer must provide a statement of the duties the MGA will be performing on their behalf |
| TPA CHECKLIST (February 2021) | TPA Checklist and Surety Bond |
| TPA ANNUAL REPORT (10/1/2019) | TPA Annual Report Filing Form |