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{"data":[["S","S","S","S","H"],["FORM NUMBER","FORM TITLE","TYPE OF DOCUMENT","CATEGORY","URL"],["INS0100","Fraud Complaint Form (Company)","Fill this form out Online","Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Investigation.Public.UI/FraudComplaintForm.aspx"],["INS0100","Fraud Complaint Form (Company)","Portable Document Format (pdf)","Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS0100.pdf"],["INS0126","Fraud Complaint Form / Person","Fill this form out Online","Consumer","https://gateway.insurance.ohio.gov/UI/ODI.Investigation.Public.UI/FraudComplaintForm.aspx"],["INS0126","Fraud Complaint Form / Person","Portable Document Format (pdf)","Consumer","https://insurance.ohio.gov/static/Forms/Documents/INS0126.pdf"],["INS0504","Third-Party Payer Response Form","Fill this form out Online","Provider","https://insurance.ohio.gov/wps/portal/gov/odi/about-us/resources/champ"],["INS0504","Third-Party Payer Response Form","Portable Document Format (pdf)","Provider","https://insurance.ohio.gov/static/Forms/Documents/INS0504.pdf"],["INS0505","Provider Complaint Form","Fill this form out Online","Insurer; Provider; Health Insuring Corporation Forms","https://insurance.ohio.gov/wps/portal/gov/odi/about-us/resources/champ"],["INS0505","Provider Complaint Form","Portable Document Format (pdf)","Insurer; Provider; Health Insuring Corporation Forms","https://insurance.ohio.gov/static/Forms/Documents/INS0505.pdf"],["INS0506","License Certification of HIPAA Compliance","Portable Document Format (pdf)","Insurer; Health Insuring Corporation Forms","https://insurance.ohio.gov/static/Forms/Documents/INS0506.pdf"],["INS0507","Credentialing and Contract Complaint Form","Fill this form out Online","Provider","https://insurance.ohio.gov/wps/portal/gov/odi/about-us/resources /contract-credentialing"],["INS0507","Credentialing and Contract Complaint Form","Portable Document Format (pdf)","Provider","https://insurance.ohio.gov/static/Forms/Documents/INS0507.pdf"],["INS0508","Credentialing and Contract Resolution Form","Fill this form out Online","Provider","https://insurance.ohio.gov/wps/portal/gov/odi/about-us/resources/secured/contract-credentialing"],["INS0508","Credentialing and Contract Resolution Form","Portable Document Format (pdf)","Provider","https://insurance.ohio.gov/static/Forms/Documents/INS0508.pdf"],["INS0510","Insurers Issuing Life Insurance Policies Certification of STOLI Prevention Procedures","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Life and Health Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS0510.pdf"],["INS1005","Insurance Complaint Form","Fill this form out Online","Consumer","https://gateway.insurance.ohio.gov/UI/ODI.CS.Public.UI/Complaint.mvc"],["INS1007","Pharmacy Benefit Manager Complaint","Fill this form out Online","Consumer","https://gateway.insurance.ohio.gov/UI/ODI.CS.Public.UI/PBMComplaint/DisplayComplaintForm"],["INS1007","Pharmacy Benefit Manager Complaint","Portable Document Format (pdf)","Consumer","https://insurance.ohio.gov/static/Forms/Documents/INS1007.pdf"],["INS2010","Insurer and Direct Participant/Member Bank Agreement","Portable Document Format (pdf)","Insurer; Other Organizations; Statutory Company Deposit Forms","https://insurance.ohio.gov/static/Forms/Documents/INS2010.pdf"],["INS2011","Book Entry Legal Deposit","Portable Document Format (pdf)","Insurer; Other Organizations; Statutory Company Deposit Forms","https://insurance.ohio.gov/static/Forms/Documents/INS2011.pdf"],["INS2072","Book Entry Deposit List","Portable Document Format (pdf)","Insurer; Other Organizations; Statutory Company Deposit Forms","https://insurance.ohio.gov/static/Forms/Documents/INS2072.pdf"],["INS2502","Missing Life Insurance/Annuity Search Request","Fill this form out Online","Consumer","https://eapps.naic.org/life-policy-locator/#/welcome"],["INS3001","Limited Lines Portable Electronics Business Entity Initial Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3001.pdf"],["INS3002","Limited Lines Portable Electronics Business Entity Renewal Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3002.pdf"],["INS3004","Application For Business Entity Navigator Certification","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3004.pdf"],["INS3006","Application for Renewal of Business Entity Navigator Certification","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3006.pdf"],["INS3007","Insurer Sponsor Acknowledgment for Ohio Resident Temporary License","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3007.pdf"],["INS3008","Notification of Changes for Business Entity (CN65)","eSignature","Agent and Business Entity","https://signer-gov.esignlive.com/ft?token=bi1IcUZaREUzOHpQX1RhUDRNQ19IMTFtZnc0PSZmYWxzZQ"],["INS3008","Notification of Changes for Business Entity (CN65)","Fill this form out Online","Agent and Business Entity","https://ohioinsurance.force.com/community/s/business-entity-changes"],["INS3008","Notification of Changes for Business Entity (CN65)","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3008.pdf"],["INS3010","Major Lines Individual Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3010.pdf"],["INS3011","Major Lines Individual Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3011.pdf"],["INS3012","Limited Lines Individual Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3012.pdf"],["INS3013","Limited Lines Individual Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3013.pdf"],["INS3014","Surety Bail Bond Individual Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3014.pdf"],["INS3015","Surety Bail Bond Individual Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3015.pdf"],["INS3016","Title/Title Insurance Marketing Representative Individual Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3016.pdf"],["INS3017","Title/Title Insurance Marketing Representative Individual Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3017.pdf"],["INS3020","Surplus Lines Individual Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3020.pdf"],["INS3021","Surplus Lines Business Entity Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3021.pdf"],["INS3022","Surplus Lines Individual Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3022.pdf"],["INS3023","Surplus Lines Business Entity Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3023.pdf"],["INS3024","Public Insurance Adjuster and Public Insurance Adjuster Agent Individual Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3024.pdf"],["INS3025","Public Insurance Adjuster Business Entity Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3025.pdf"],["INS3026","Public Insurance Adjuster and Public Insurance Adjuster Agent Individual Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3026.pdf"],["INS3027","Public Insurance Adjuster Business Entity Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3027.pdf"],["INS3028","Managing General Agent Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3028.pdf"],["INS3029","Managing General Agent Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3029.pdf"],["INS3030","Reinsurance Intermediary Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3030.pdf"],["INS3031","Reinsurance Intermediary Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3031.pdf"],["INS3032","Limited Lines Portable Electronics Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3032.pdf"],["INS3033","Limited Lines Portable Electronics Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3033.pdf"],["INS3034","Major Lines Business Entity Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3034.pdf"],["INS3035","Major Lines Business Entity Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3035.pdf"],["INS3036","Limited Lines Business Entity Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3036.pdf"],["INS3037","Limited Lines Business Entity Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3037.pdf"],["INS3038","Title Business Entity Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3038.pdf"],["INS3039","Title Business Entity Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3039.pdf"],["INS3040","Surety Bail Bond Business Entity Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3040.pdf"],["INS3041","Surety Bail Bond Business Entity Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3041.pdf"],["INS3042","Viatical Broker Individual Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3042.pdf"],["INS3043","Viatical Broker Individual Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3043.pdf"],["INS3044","Viatical Broker Entity Initial License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3044.pdf"],["INS3045","Viatical Broker Entity Renewal License Application Checklist","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3045.pdf"],["INS3048","Pre-Licensing Education Provider Approval Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3048.pdf"],["INS3049","Pre-License Education Provider Renewal Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3049.pdf"],["INS3052","Pre-Licensing Education Instructor Approval Registration","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3052.pdf"],["INS3056","Registration For Pre-Licensing Authorized Provider Official Approval","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3056.pdf"],["INS3058","Pre-License School Filing Requirements","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3058.pdf"],["INS3059","Pre-Licensing Education Financial Interest Statement","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3059.pdf"],["INS3061","Self-Service Storage Business Entity Renewal Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3061.pdf"],["INS3062","Self-Service Storage Business Entity License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3062.pdf"],["INS3063","Travel Retailer Registration Form","eSignature","Agent and Business Entity","https://signer-gov.esignlive.com/ft?token=T0FLUERWR0ZxdTFrLUNpNmJOeFJMdnVmRlpzPSZmYWxzZQ"],["INS3063","Travel Retailer Registration Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3063.pdf"],["INS3064","Limited Lines BE Initial Travel Insurance Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3064.pdf"],["INS3065","Limited Lines BE Renewal Travel Insurance Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3065.pdf"],["INS3066","Limited Lines Rental Car Insurance Initial & Renewal Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3066.pdf"],["INS3067","Limited Lines Self-Service Storage BE Initial & Renewal Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3067.pdf"],["INS3090","Ohio Individual Agent Initial Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3090.pdf"],["INS3091","Ohio Individual Agent Renewal Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3091.pdf"],["INS3206","Third Party Administrators (TPA) License Renewal/Continuation Application Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3206.pdf"],["INS3210","Individual Third Party Administrators (TPA) License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3210.pdf"],["INS3211","Business Entity Third Party Administrators (TPA) License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3211.pdf"],["INS3212","Individual Third Party Administrators (TPA) License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3212.pdf"],["INS3213","Business Entity Third Party Administrators (TPA) License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3213.pdf"],["INS3214","Individual Public Insurance Adjuster Certificate of Authority License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3214.pdf"],["INS3215","Business Entity Public Insurance Adjuster Certificate of Authority License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3215.pdf"],["INS3216","Electronic Individual Public Insurance Adjuster Supplement Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3216.pdf"],["INS3217","Electronic Business Entity Public Insurance Adjuster Supplement Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3217.pdf"],["INS3218","Individual Viatical Settlement Broker License Application","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3218.pdf"],["INS3219","Individual Viatical Settlement Broker License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3219.pdf"],["INS3220","Business Entity Viatical Settlement Broker License Application","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3220.pdf"],["INS3221","Business Entity Viatical Settlement Broker License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3221.pdf"],["INS3222","Ohio Specific Surplus Lines Broker Bond Form","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3222.pdf"],["INS3222","Ohio Specific Surplus Lines Broker Bond Form","eSignature","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://signer-gov.esignlive.com/ft?token=U2lYOFZVcVpiVGNtV19FMUVsbHNxOHdwU21nPSZmYWxzZQ"],["INS3223","Business Entity Surplus Lines Broker License Application","Portable Document Format (pdf)","Agent and Business Entity; Other Organizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3223.pdf"],["INS3225","Pre-Licensing Publisher List","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3225.pdf"],["INS3235","License Inactivation Request","eSignature","Agent and Business Entity","https://signer-gov.esignlive.com/ft?token=TVNJVmkyWmVWMHN5NjYxczZyVHZoeFRzRW1jPSZmYWxzZQ"],["INS3235","License Inactivation Request","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3235.pdf"],["INS3236","License Reactivation Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3236.pdf"],["INS3239","Viatical Settlement Registered Life Agent","eSignature","Agent and Business Entity; Viatical/Life Settlement","https://signer-gov.esignlive.com/ft?token=QzhjVzBDWHhrOEJvUkV4RUtkTEl0eXhkWTNvPSZmYWxzZQ"],["INS3239","Viatical Settlement Registered Life Agent","Portable Document Format (pdf)","Agent and Business Entity; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3239.pdf"],["INS3240","Individual Agent License Surrender Form","eSignature","Agent and Business Entity","https://signer-gov.esignlive.com/ft?token=TUVINmZmYmhkel9BaEtzQUgxZFhQZmgzTm9ZPSZmYWxzZQ"],["INS3240","Individual Agent License Surrender Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3240.pdf"],["INS3241","Individual Agent Name/Address Change Request Form","eSignature","Agent and Business Entity","https://signer-gov.esignlive.com/ft?token=cTgtUDZzWUh3dF9GM2RIU25uTF9oc25MR1UwPSZmYWxzZQ"],["INS3241","Individual Agent Name/Address Change Request Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3241.pdf"],["INS3243","Individual Title Agent License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3243.pdf"],["INS3244","Business Entity Title License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3244.pdf"],["INS3245","Individual Surplus Lines Broker License Application","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3245.pdf"],["INS3249","Individual Managing General Agent (MGA) License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3249.pdf"],["INS3250","Business Entity Managing General Agent (MGA) License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3250.pdf"],["INS3251","Individual Surety Bail Bond License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3251.pdf"],["INS3252","Business Entity Surety Bail Bond License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3252.pdf"],["INS3254","Clearance Request Voluntary Surrender Form","Portable Document Format (pdf)","Agent","https://insurance.ohio.gov/static/Forms/Documents/INS3254.pdf"],["INS3255","Individual Surety Bail Bond License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3255.pdf"],["INS3256","Business Entity Surety Bail Bond License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3256.pdf"],["INS3257","Home State Certification Letter Request","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3257.pdf"],["INS3258","Individual Title License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3258.pdf"],["INS3259","Business Entity Title License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3259.pdf"],["INS3260","Notice to All Pre-License Schools Regarding Bulletins","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3260.pdf"],["INS3261","Pre-Licensing Student Course Completion Certificate Guidelines","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3261.pdf"],["INS3266","Third Party Administrator License Application Review Checklist","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3266.pdf"],["INS3271","Individual Surplus Lines Broker License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3271.pdf"],["INS3272","Business Entity Surplus Lines Broker License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS3272.pdf"],["INS3276","Pre-License Education Waiver Request","eSignature","Agent and Business Entity","https://signer-gov.esignlive.com/ft?token=T2EzZmViOE9meFE0RHNWTTdRSzc5NkVtQ2Y0PSZmYWxzZQ"],["INS3276","Pre-License Education Waiver Request","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3276.pdf"],["INS3278","Individual Managing General Agent (MGA) License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3278.pdf"],["INS3279","Business Entity Managing General Agent (MGA) License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3279.pdf"],["INS3281","Viatical Settlement Provider License Voluntary Surrender","Portable Document Format (pdf)","Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS3281.pdf"],["INS3283.19","2019 Annual Title Agent Review Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3283.19.pdf"],["INS3283.20","2020 Annual Title Agent Review Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3283.20.pdf"],["INS3287","Individual Public Insurance Adjuster Certificate of Authority Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3287.pdf"],["INS3288","Business Entity Public Insurance Adjuster Certificate of Authority Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3288.pdf"],["INS3289","Individual Reinsurance Intermediary License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3289.pdf"],["INS3290","Business Entity Reinsurance Intermediary License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3290.pdf"],["INS3291","Individual Reinsurance Intermediary License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3291.pdf"],["INS3292","Business Entity Reinsurance Intermediary License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3292.pdf"],["INS3293","Individual Title Insurance Marketing Representative (TIMR) License Application","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3293.pdf"],["INS3294","Individual Title Insurance Marketing Representative (TIMR) License Renewal/Continuation","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3294.pdf"],["INS3295","Electronic Managing General Agent (MGA) Supplemental Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3295.pdf"],["INS3296","Electronic Individual Title Insurance Marketing Representative (TIMR) Sponsorship Form","eSignature","Agent and Business Entity","https://signer-gov.esignlive.com/ft?token=U1pEcUsydlJkQTh6Sk1DeTFhTDI0aEo2NUwwPSZmYWxzZQ"],["INS3296","Electronic Individual Title Insurance Marketing Representative (TIMR) Sponsorship Form","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/Documents/INS3296.pdf"],["INS4001","Surplus Lines Premium Tax Summary","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS4001.pdf"],["INS4012","Property and Casualty Profit & Loss Statement","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS4012.pdf"],["INS4023","Direct Procurement Statement","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Organizations; Property & Casualty and Title Company Forms; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS4023.pdf"],["INS4024","Surplus Lines Statement","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Other Ogranizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS4024.pdf"],["INS5001","Life Insurance Company Certification of Filing Compliance with ORC 3916.05(B) and OAC Rule 3901-9-04","Portable Document Format (pdf)","Insurer; Life and Health Company Forms; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS5001.pdf"],["INS5002","Life Insurer Application Form STOLI Question Review Guidelines","Portable Document Format (pdf)","Insurer; Life and Health Company Forms; Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS5002.pdf"],["INS5025","MEWA Certificate of Authority Application Requirements","Portable Document Format (pdf)","Insurer; MEWA; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS5025.pdf"],["INS5027","Application for a Small Employer Health Care Alliance Certificate of Authority","Portable Document Format (pdf)","Other Organizations; Small Employer Healthcare Alliances","https://insurance.ohio.gov/static/Forms/Documents/INS5027.pdf"],["INS5028","Renewal Application for a Small Employer Health Care Alliance Certificate of Authority","Portable Document Format (pdf)","Other Organizations; Small Employer Healthcare Alliances","https://insurance.ohio.gov/static/Forms/Documents/INS5028.pdf"],["INS5034","Renewal Application for Accreditation as an Independent Review Organization","Portable Document Format (pdf)","Independent Review Organizations; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS5034.pdf"],["INS5035","Application for Accreditation as an Independent Review Organization","Portable Document Format (pdf)","Independent Review Organizations; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS5035.pdf"],["INS5036","Standardized Credentialing Form Part B","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Provider","https://insurance.ohio.gov/static/Forms/Documents/INS5036.pdf"],["INS5037","Application for Accreditation as an IRO:Biographical Questionnaire","Portable Document Format (pdf)","Independent Review Organizations; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS5037.pdf"],["INS6012","Enforcement Complaint Form","Fill this form out Online","Consumer; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Enf.Public.UI/Complaint/DisplayComplaintInformation"],["INS6012","Enforcement Complaint Form","Portable Document Format (pdf)","Consumer; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS6012.pdf"],["INS6013","Agent Termination For Cause Form","Fill this form out Online","Agent and Business Entity; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://ohioinsurance.force.com/community/s/agent-termination-form"],["INS6013","Agent Termination For Cause Form","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS6013.pdf"],["INS7001","Insurance Regulatory Information System","Portable Document Format (pdf)","Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7001.pdf"],["INS7003","Application for Approval to Write Excess and Surplus Lines Insurance in Ohio","Portable Document Format (pdf)","Insurer; Other Organizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/Documents/INS7003.pdf"],["INS7004","Application for Certificate of Authority - Fraternal Benefit Societies Mutual Protective Associations and Title Companies","Portable Document Format (pdf)","Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7004.pdf"],["INS7004","Application for Certificate of Authority - Fraternal Benefit Societies Mutual Protective Associations and Title Companies","eSignature","Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://signer-gov.esignlive.com/ft?token=SXgteXRZQTVaM1czRm5pa1NuVjNwczV6cHhnPSZmYWxzZQ"],["INS7005","Application For Certificate of Authority - P&C","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7005.pdf"],["INS7005","Application For Certificate of Authority - P&C","eSignature","Insurer; Property & Casualty and Title Company Forms","https://signer-gov.esignlive.com/ft?token=b21MVDNQSzVTaEQ3ZG5VTXNsUFNTQ3loWEtvPSZmYWxzZQ"],["INS7006","Application For Certificate of Authority - Life","Portable Document Format (pdf)","Insurer; Life and Health Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7006.pdf"],["INS7006","Application For Certificate of Authority - Life","eSignature","Insurer; Life and Health Company Forms","https://signer-gov.esignlive.com/ft?token=M1YzbDc4c0docC1PeW81a0xYUlBKbDlNOXRjPSZmYWxzZQ"],["INS7008","Statement of Actuarial Opinion Exemption Affidavit for Insurance Companies*","Portable Document Format (pdf)","Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7008.pdf"],["INS7014","Ohio Automobile Insurance Plan (Auto Ins.)","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7014.pdf"],["INS7014","Ohio Automobile Insurance Plan (Auto Ins.)","eSignature","Insurer; Property & Casualty and Title Company Forms","https://signer-gov.esignlive.com/ft?token=VmRQdl8zZ1ZYQ0tTT0o3dlc2eWJjUWNyTDdrPSZmYWxzZQhttps://signer-gov.esignlive.com/ft?token=VmRQdl8zZ1ZYQ0tTT0o3dlc2eWJjUWNyTDdrPSZmYWxzZQ"],["INS7015","Ohio Fair Plan Underwriting Association (Homeowners/property)","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7015.pdf"],["INS7015","Ohio Fair Plan Underwriting Association (Homeowners/property)","eSignature","Insurer; Property & Casualty and Title Company Forms","https://signer-gov.esignlive.com/ft?token=a0JDaW1qNXA1WlpId1ZhTl92ZzNkYmM0eUtFPSZmYWxzZQ"],["INS7016","Ohio Fire Marshal Tax Return","Fill this form out Online","Insurer; Property & Casualty and Title Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7016","Ohio Fire Marshal Tax Return","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7016.pdf"],["INS7020","Captive Insurance Company License Application","Portable Document Format (pdf)","Captive Insurance; Insurer; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS7020.pdf"],["INS7021","Pure or Protected Cell Captive Insurance Company Annual Statement, Premium Based Fee & Payment Voucher","Microsoft Excel Document (xls)","Captive Insurance; Insurer; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS7021.xlsx"],["INS7022","Captive Insurance Company Biographical Affidavit","Portable Document Format (pdf)","Captive Insurance; Insurer; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS7022.pdf"],["INS7023","Special Purpose Financial Captive Insurance Company Premium Based Fee & Payment Voucher","Microsoft Excel Document (xls)","Captive Insurance; Insurer; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS7023.xlsx"],["INS7024","Annual Renewal Fee Captive Insurance Company Payment Voucher","Portable Document Format (pdf)","Captive Insurance; Insurer; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS7024.pdf"],["INS7058","Application For Certificate of Authority - MEWA'S","Portable Document Format (pdf)","Insurer; MEWA; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS7058.pdf"],["INS7058","Application For Certificate of Authority - MEWA'S","eSignature","Insurer; MEWA; Other Organizations","https://signer-gov.esignlive.com/ft?token=ZUhYME9QX3M1ZlhoWnBWOEVzNGg2ZHdRZGVRPSZmYWxzZQ"],["INS7059","Instructions For Filing Annual & Quarterly Statements - MEWA'S","Portable Document Format (pdf)","Insurer; MEWA; Other Organizations","https://insurance.ohio.gov/static/Forms/Documents/INS7059.pdf"],["INS7062","Internet & Diskette Submissions of A/S to NAIC","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7062.pdf"],["INS7140","Exhibit A Tax Credit - All Foreign & Domestic Insurers","Fill this form out Online","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7140","Exhibit A Tax Credit - All Foreign & Domestic Insurers","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7140.pdf"],["INS7141","Domestic Health Insuring Corporation Franchise Tax Form","Fill this form out Online","Health Insuring Corporation Forms; Insurer","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7141","Domestic Health Insuring Corporation Franchise Tax Form","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS7141.pdf"],["INS7142","Domestic Life Insurance Company Franchise Tax Form","Fill this form out Online","Insurer; Life and Health Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7142","Domestic Life Insurance Company Franchise Tax Form","Portable Document Format (pdf)","Insurer; Life and Health Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7142.pdf"],["INS7143","Domestic Property & Casualty Franchise Tax Form","Fill this form out Online","Insurer; Property & Casualty and Title Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7143","Domestic Property & Casualty Franchise Tax Form","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7143.pdf"],["INS7144","Domestic Fire Assessment Association Franchise Tax Form","Fill this form out Online","Insurer; Property & Casualty and Title Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7144","Domestic Fire Assessment Association Franchise Tax Form","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7144.pdf"],["INS7145","Foreign Health Insuring Corporation Premium Tax Form","Fill this form out Online","Health Insuring Corporation Forms; Insurer","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7145","Foreign Health Insuring Corporation Premium Tax Form","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS7145.pdf"],["INS7146","Foreign Life Insurance Company Premium Tax Form","Fill this form out Online","Insurer; Life and Health Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7146","Foreign Life Insurance Company Premium Tax Form","Portable Document Format (pdf)","Insurer; Life and Health Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7146.pdf"],["INS7147","Foreign Property & Casualty Premium Tax Form","Fill this form out Online","Insurer; Property & Casualty and Title Company Forms","https://gateway.insurance.ohio.gov/UI/ODI.Saap.Gateway.UI/Account.mvc/LogOn"],["INS7147","Foreign Property & Casualty Premium Tax Form","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7147.pdf"],["INS7148","Dividend Deductions For Premium Taxes - Foreign P&C Insurers","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7148.pdf"],["INS7150","Computation of Deposits - Domestic Title Co's","Microsoft Excel Document (xls)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7150.xls"],["INS7151","Computation of Deposits - Domestic Title & Trust Co's","Microsoft Excel Document (xls)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7151.xls"],["INS7152","Computation of Deposits - Foreign Title Co's","Microsoft Excel Document (xls)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7152.xls"],["INS7160","Filing of Audited Financial Statements","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7160.pdf"],["INS7166","Audited Financial Statement Exemption Affidavit","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7166.pdf"],["INS7168","Financial Disclosure Form - HIC's","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS7168.pdf"],["INS7186","Exemption Affidavit For Actuarial Opinion - Ohio Titles","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7186.pdf"],["INS7214","Domestic Insurance Tax Summary","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7214.pdf"],["INS7215","Foreign & Alien Insurance Tax Summary","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7215.pdf"],["INS7219","Cost Sharing Agreement Review (Form D)","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7219.pdf"],["INS7221","Review of Application for Approval of Acquisition of Domestic Insurer (Form A)","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7221.pdf"],["INS7226","Exhibit of Premiums Enrollment and Utilization - HMO","Microsoft Excel Document (xls)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7226.xlsx"],["INS7239","Dividend/Distribution Notification Filing ORC 3901.33, 3901.34(C), 3901.37(B), 3964.06","Portable Document Format (pdf)","Captive Insurance; Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Other Organizations; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7239.pdf"],["INS7239","Dividend/Distribution Notification Filing ORC 3901.33, 3901.34(C), 3901.37(B), 3964.06","eSignature","Captive Insurance; Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Other Organizations; Property & Casualty and Title Company Forms","https://signer-gov.esignlive.com/ft?token=bWU2U3JKTUcwYkxXM05hZDhNT0I0NEZjd1hZPSZmYWxzZQ"],["INS7240","Electronic Filing Authenticity Affidavit","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7240.pdf"],["INS7240","Electronic Filing Authenticity Affidavit","eSignature","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://signer-gov.esignlive.com/ft?token=Y3B4Ymg0VkJFVUtvOWItX005dGF0REtaSHJFPSZmYWxzZQ"],["INS7240","Electronic Filing Authenticity Affidavit eSignature Instructions","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7240_eSignature_Instructions.pdf"],["INS7248","Viatical/Life Settlement Annual Statement for Providers","Portable Document Format (pdf)","Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS7248.pdf"],["INS7254","Biographical Affidavit - Viatical Applications","Portable Document Format (pdf)","Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS7254.pdf"],["INS7255","Disclosure and Authorization Concerning Background Reports - Viatical Applications","Portable Document Format (pdf)","Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS7255.pdf"],["INS7257","Disclosure And Authorization Concerning Background Reports - Mergers and Acquisitions","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/INS7257.pdf"],["INS9008","Requirements for HIC Major Modification","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9008.pdf"],["INS9011","Filing Requirements for COA or Service Area Expansion Request","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9011.pdf"],["INS9012","Flesch Reading Ease Test","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9012.pdf"],["INS9014","HIC Deposit & Filing Fee Schedule","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9014.pdf"],["INS9016","HIC Provider / HCF Contract Certification Form","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9016.pdf"],["INS9022","HIC Solicitation Review Guidelines & Checklist","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9022.pdf"],["INS9025","Quality Assurance Programs Certification of Compliance","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9025.pdf"],["INS9026","Utilization Review Programs Certification of Compliance","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9026.pdf"],["INS9032","Instructions for Application for a Health Insuring Corporation Certificate of Authority","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9032.pdf"],["INS9060","Form of Required $250000.00 Deposit","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9060.pdf"],["INS9071","Guaranty","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9071.pdf"],["INS9073","Application for a Health Insuring Corporation Certificate of Authority","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9073.pdf"],["INS9073","Application for a Health Insuring Corporation Certificate of Authority","eSignature","Health Insuring Corporation Forms; Insurer","https://signer-gov.esignlive.com/ft?token=c3J2d0QzUXpyZ0JZRkxjMml5SF9xZzNGcmpZPSZmYWxzZQ"],["INS9074","Filing Requirements For Service Area Expansion Request","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/Documents/INS9074.pdf"],["INS9105","Viatical Settlement Provider License Application Checklist","Portable Document Format (pdf)","Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS9105.pdf"],["INS9106","Viatical Settlement Provider License Application","Portable Document Format (pdf)","Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS9106.pdf"],["INS9107","Viatical Settlement Provider License Renewal Application","Portable Document Format (pdf)","Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS9107.pdf"],["INS9108","Viatical Settlement Provider License Renewal Application Checklist","Portable Document Format (pdf)","Viatical/Life Settlement","https://insurance.ohio.gov/static/Forms/Documents/INS9108.pdf"],["INSNON","Adoption of Rating Bureau Prospective Loss Cost","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/NAIC_LossCostAdoption.LCExhibitA.pdf"],["INSNON","Calculation of Company Loss Cost Multiplier","Portable Document Format (pdf)","Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/NAIC_LossCostSummary.LCExhibitB.pdf"],["INSNON","Ohio Title Agent Surety Bond","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/Documents/OhioTitleAgentSuretyBond.pdf"],["INSNON","Performance Bond Form for Medicaid HICs","Portable Document Format (pdf)","Health Insuring Corporation Forms; Insurer","https://insurance.ohio.gov/static/Forms/PerformanceBondHICs.pdf"],["NAIC","Business Entity License Application - NAIC 2014","Fill this form out Online","Agent and Business Entity","https://www.nipr.com/license_form.htm?l"],["NAIC","Business Entity Renewal Application - NAIC 2014","Fill this form out Online","Agent and Business Entity","https://www.nipr.com/license_form.htm?r"],["NAIC","Individual Producer License Application - NAIC 2014","Fill this form out Online","Agent and Business Entity","https://www.nipr.com/license_form.htm?l"],["NAIC","Individual Producer Renewal Application - NAIC 2014","Fill this form out Online","Agent and Business Entity","https://www.nipr.com/license_form.htm?r"],["NAIC","Business Entity License Application - NAIC 2014","Other External Link","Agent and Business Entity","https://www.nipr.com/license_form.htm"],["NAIC","Business Entity Renewal Application - NAIC 2014","Other External Link","Agent and Business Entity","https://www.nipr.com/license_form.htm"],["NAIC","Individual Producer License Application - NAIC 2014","Other External Link","Agent and Business Entity","https://www.nipr.com/license_form.htm"],["NAIC","Individual Producer Renewal Application - NAIC 2014","Other External Link","Agent and Business Entity","https://www.nipr.com/license_form.htm"],["NAIC","Business Entity License Application - NAIC 2014","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/NAIC2014_BEInitialApplication.pdf"],["NAIC","Business Entity Renewal Application - NAIC 2014","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/NAIC2014_BERenewalApplication.pdf"],["NAIC","Individual Producer License Application - NAIC 2014","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/NAIC2014_IndividualInitialApplication.pdf"],["NAIC","Individual Producer Renewal Application - NAIC 2014","Portable Document Format (pdf)","Agent and Business Entity","https://insurance.ohio.gov/static/Forms/NAIC2014_IndividualRenewalApplication.pdf"],["NAIC","NAIC Application For Written Consent To Engage In The Business Of Insurance (1033)","Portable Document Format (pdf)","Agent and Business Entity; Insurer; Life and Health Company Forms; Property & Casualty and Title Company Forms","https://insurance.ohio.gov/static/Forms/NAIC_AppforWrittenConsenttoEngageintheBusinessIns1033.1034.pdf"],["NAIC","Risk Purchasing Group Registration Form","Portable Document Format (pdf)","Insurer; Other Organizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/NAIC_PurchasingGroupNoticeandRegistration.pdf"],["NAIC","Risk Retention Group Registration Form","Portable Document Format (pdf)","Insurer; Other Organizations; Surplus Lines, Risk Retention Groups, Risk Purchasing Groups","https://insurance.ohio.gov/static/Forms/NAIC_RiskRetentionGroupNoticeandRegistration.pdf"],[""]],"errors":[],"meta":{"delimiter":",","linebreak":"\r\n","aborted":false,"truncated":false,"cursor":53074}}
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