Connecticut Insurance Department Forms
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Form SL-8 "Surplus Lines Statement" - Connecticut
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Form AR-1 "Certificate of Assuming Insurer" - Connecticut
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"Request for External Review" - Connecticut
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"Captive Insurance Company - Application for Admission" - Connecticut
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114 votes
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"Captive Insurance Company Irrevocable Letter of Credit (Template)" - Connecticut
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"Utilization Review License Application Form" - Connecticut
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17 votes
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"Request to Change Residency Moving to or From Connecticut" - Connecticut
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57 votes
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"Connecticut Surety Bail Bond Initial License Application Form" - Connecticut
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98 votes
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"Consumer Complaint Form" - Connecticut
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"Rental Car Agency Permit Application Form" - Connecticut
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92 votes
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"Rental Car Agency Company Appointment Application Form" - Connecticut
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49 votes
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"Medical Discount Plan (Mdp) License Renewal Form" - Connecticut
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15 votes
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"Application for Individual Fraternal Agent License/Appointment" - Connecticut
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31 votes
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"General Agent Agreement Form" - Connecticut
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"Pharmacy Benefits Manager (Pbm) Renewal Application for a Certificate of Registration" - Connecticut
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"Preferred Provider Network (Ppn) License Application Form" - Connecticut
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40 votes
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"Preferred Provider Network (Ppn) License Renewal Application Form (Renewal)" - Connecticut
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51 votes
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"Pharmacy Benefits Manager Certificate of Registration - Initial Application Form" - Connecticut
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6 votes
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"Application for Life Settlement Provider License" - Connecticut
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"Life Settlement Provider Renewal Application Form" - Connecticut
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"Medical Discount Plant (Mdp) License Renewal Form" - Connecticut
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29 votes
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"License Cancel/Termination Form" - Connecticut
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"Application for Recognition - Captive Insurance Company Actuarial Services and Opinions and/or Loss Reserve/Expense Certification" - Connecticut
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46 votes
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"Connecticut Continuation Coverage Election Notice Form" - Connecticut
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14 votes
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1 MB
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"Bail Bond Surety Company Audit Findings Report Form" - Connecticut
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40 votes
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176 KB
7 pages
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"Reinsurance Intermediary Power of Attorney (Nonresident Corporation)" - Connecticut
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46 votes
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"Reinsurance Intermediary Power of Attorney (Nonresident Individual)" - Connecticut
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"Reinsurance Intermediary Power of Attorney (Nonresident Non-corporation)" - Connecticut
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"Public Health Fee Assessment Request" - Connecticut, 2022
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37 votes
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"Health and Welfare Fee (Childhood Vaccinations) Assessment Request" - Connecticut, 2022
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23 votes
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"Application for Recognition - Captive Insurance Company Manager" - Connecticut
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"Application for Recognition - Captive Insurance Company Independent Certified Public Accountant" - Connecticut
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57 votes
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"Life Producer Registration to Act as a Life Settlement Broker Individual Registration Form" - Connecticut
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58 votes
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"Life Producer Registration to Act as a Life Settlement Broker Business Entity Registration Form" - Connecticut
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"Portable Electronic Insurance License Application Form" - Connecticut
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12 votes
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5 pages
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"Premium Finance Company Renewal Application Form" - Connecticut
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50 votes
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"Application to Be a Qualified Vendor of Behavioral Health Clinical Review Criteria" - Connecticut
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7 votes
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"Consumer Report Card Addendum Form (All Networks)" - Connecticut
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69 votes
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"Annual Peo Certification Form" - Connecticut
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13 votes
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"Third Party Administrator (Tpa) Registration" - Connecticut
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71 votes
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![Form SL-8 "Surplus Lines Statement" - Connecticut](https://data.templateroller.com/pdf_docs_html/1763/17639/1763986/form-sl-8-surplus-lines-statement-connecticut.png "Form SL-8 "Surplus Lines Statement" - Connecticut")
![Form AR-1 "Certificate of Assuming Insurer" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781368/form-ar-1-certificate-assuming-insurer-connecticut.png "Form AR-1 "Certificate of Assuming Insurer" - Connecticut")
!["Request for External Review" - Connecticut](https://data.templateroller.com/pdf_docs_html/2260/22604/2260412/request-for-external-review-connecticut.png ""Request for External Review" - Connecticut")
!["Captive Insurance Company - Application for Admission" - Connecticut](https://data.templateroller.com/pdf_docs_html/2224/22240/2224036/captive-insurance-company-application-for-admission-connecticut.png ""Captive Insurance Company - Application for Admission" - Connecticut")
!["Captive Insurance Company Irrevocable Letter of Credit (Template)" - Connecticut](https://data.templateroller.com/pdf_docs_html/2224/22240/2224032/captive-insurance-company-irrevocable-letter-of-credit-template-connecticut.png ""Captive Insurance Company Irrevocable Letter of Credit (Template)" - Connecticut")
!["Utilization Review License Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781394/utilization-review-license-application-form-connecticut.png ""Utilization Review License Application Form" - Connecticut")
!["Request to Change Residency Moving to or From Connecticut" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781350/request-to-change-residency-moving-to-or-from-connecticut-connecticut.png ""Request to Change Residency Moving to or From Connecticut" - Connecticut")
!["Connecticut Surety Bail Bond Initial License Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781352/connecticut-surety-bail-bond-initial-license-application-form-connecticut.png ""Connecticut Surety Bail Bond Initial License Application Form" - Connecticut")
!["Consumer Complaint Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781345/consumer-complaint-form-connecticut.png ""Consumer Complaint Form" - Connecticut")
!["Rental Car Agency Permit Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781363/rental-car-agency-permit-application-form-connecticut.png ""Rental Car Agency Permit Application Form" - Connecticut")
!["Rental Car Agency Company Appointment Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781365/rental-car-agency-company-appointment-application-form-connecticut.png ""Rental Car Agency Company Appointment Application Form" - Connecticut")
!["Medical Discount Plan (Mdp) License Renewal Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17814/1781415/medical-discount-plan-mdp-license-renewal-form-connecticut.png ""Medical Discount Plan (Mdp) License Renewal Form" - Connecticut")
!["Application for Individual Fraternal Agent License/Appointment" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781359/application-individual-fraternal-agent-license-appointment-connecticut.png ""Application for Individual Fraternal Agent License/Appointment" - Connecticut")
!["General Agent Agreement Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781377/general-agent-agreement-form-connecticut.png ""General Agent Agreement Form" - Connecticut")
!["Pharmacy Benefits Manager (Pbm) Renewal Application for a Certificate of Registration" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781361/pharmacy-benefits-manager-pbm-renewal-application-a-certificate-registration-connecticut.png ""Pharmacy Benefits Manager (Pbm) Renewal Application for a Certificate of Registration" - Connecticut")
!["Preferred Provider Network (Ppn) License Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781366/preferred-provider-network-ppn-license-application-form-connecticut.png ""Preferred Provider Network (Ppn) License Application Form" - Connecticut")
!["Preferred Provider Network (Ppn) License Renewal Application Form (Renewal)" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781370/preferred-provider-network-ppn-license-renewal-application-form-renewal-connecticut.png ""Preferred Provider Network (Ppn) License Renewal Application Form (Renewal)" - Connecticut")
!["Pharmacy Benefits Manager Certificate of Registration - Initial Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781373/pharmacy-benefits-manager-certificate-registration-initial-application-form-connecticut.png ""Pharmacy Benefits Manager Certificate of Registration - Initial Application Form" - Connecticut")
!["Application for Life Settlement Provider License" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781378/application-life-settlement-provider-license-connecticut.png ""Application for Life Settlement Provider License" - Connecticut")
!["Life Settlement Provider Renewal Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781355/life-settlement-provider-renewal-application-form-connecticut.png ""Life Settlement Provider Renewal Application Form" - Connecticut")
!["Medical Discount Plant (Mdp) License Renewal Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781395/medical-discount-plant-mdp-license-renewal-form-connecticut.png ""Medical Discount Plant (Mdp) License Renewal Form" - Connecticut")
!["License Cancel/Termination Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1767/17672/1767242/license-cancel-termination-form-connecticut.png ""License Cancel/Termination Form" - Connecticut")
!["Application for Recognition - Captive Insurance Company Actuarial Services and Opinions and/or Loss Reserve/Expense Certification" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781332/application-recognition-captive-insurance-company-actuarial-services-and-opinions-and-or-loss-reserve-expense-certification-connecticut.png ""Application for Recognition - Captive Insurance Company Actuarial Services and Opinions and/or Loss Reserve/Expense Certification" - Connecticut")
!["Connecticut Continuation Coverage Election Notice Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1765/17651/1765106/connecticut-continuation-coverage-election-notice-form-connecticut.png ""Connecticut Continuation Coverage Election Notice Form" - Connecticut")
!["Bail Bond Surety Company Audit Findings Report Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781364/bail-bond-surety-company-audit-findings-report-form-connecticut.png ""Bail Bond Surety Company Audit Findings Report Form" - Connecticut")
!["Reinsurance Intermediary Power of Attorney (Nonresident Corporation)" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781362/reinsurance-intermediary-power-attorney-nonresident-corporation-connecticut.png ""Reinsurance Intermediary Power of Attorney (Nonresident Corporation)" - Connecticut")
!["Reinsurance Intermediary Power of Attorney (Nonresident Individual)" - Connecticut](https://data.templateroller.com/pdf_docs_html/1767/17673/1767396/reinsurance-intermediary-power-attorney-nonresident-individual-connecticut.png ""Reinsurance Intermediary Power of Attorney (Nonresident Individual)" - Connecticut")
!["Reinsurance Intermediary Power of Attorney (Nonresident Non-corporation)" - Connecticut](https://data.templateroller.com/pdf_docs_html/1767/17673/1767382/reinsurance-intermediary-power-attorney-nonresident-non-corporation-connecticut.png ""Reinsurance Intermediary Power of Attorney (Nonresident Non-corporation)" - Connecticut")
!["Public Health Fee Assessment Request" - Connecticut, 2022](https://data.templateroller.com/pdf_docs_html/2433/24330/2433055/public-health-fee-assessment-request-connecticut.png ""Public Health Fee Assessment Request" - Connecticut, 2022")
!["Health and Welfare Fee (Childhood Vaccinations) Assessment Request" - Connecticut, 2022](https://data.templateroller.com/pdf_docs_html/2433/24330/2433054/health-and-welfare-fee-childhood-vaccinations-assessment-request-connecticut.png ""Health and Welfare Fee (Childhood Vaccinations) Assessment Request" - Connecticut, 2022")
!["Application for Recognition - Captive Insurance Company Manager" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781334/application-recognition-captive-insurance-company-manager-connecticut.png ""Application for Recognition - Captive Insurance Company Manager" - Connecticut")
!["Application for Recognition - Captive Insurance Company Independent Certified Public Accountant" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781336/application-recognition-captive-insurance-company-independent-certified-public-accountant-connecticut.png ""Application for Recognition - Captive Insurance Company Independent Certified Public Accountant" - Connecticut")
!["Life Producer Registration to Act as a Life Settlement Broker Individual Registration Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781353/life-producer-registration-to-act-as-a-life-settlement-broker-individual-registration-form-connecticut.png ""Life Producer Registration to Act as a Life Settlement Broker Individual Registration Form" - Connecticut")
!["Life Producer Registration to Act as a Life Settlement Broker Business Entity Registration Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781354/life-producer-registration-to-act-as-a-life-settlement-broker-business-entity-registration-form-connecticut.png ""Life Producer Registration to Act as a Life Settlement Broker Business Entity Registration Form" - Connecticut")
!["Portable Electronic Insurance License Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781367/portable-electronic-insurance-license-application-form-connecticut.png ""Portable Electronic Insurance License Application Form" - Connecticut")
!["Premium Finance Company Renewal Application Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781371/premium-finance-company-renewal-application-form-connecticut.png ""Premium Finance Company Renewal Application Form" - Connecticut")
!["Application to Be a Qualified Vendor of Behavioral Health Clinical Review Criteria" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781372/application-to-be-a-qualified-vendor-behavioral-health-clinical-review-criteria-connecticut.png ""Application to Be a Qualified Vendor of Behavioral Health Clinical Review Criteria" - Connecticut")
!["Consumer Report Card Addendum Form (All Networks)" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781376/consumer-report-card-addendum-form-all-networks-connecticut.png ""Consumer Report Card Addendum Form (All Networks)" - Connecticut")
!["Annual Peo Certification Form" - Connecticut](https://data.templateroller.com/pdf_docs_html/1781/17813/1781382/annual-peo-certification-form-connecticut.png ""Annual Peo Certification Form" - Connecticut")
!["Third Party Administrator (Tpa) Registration" - Connecticut](https://data.templateroller.com/pdf_docs_html/1767/17673/1767392/third-party-administrator-tpa-registration-connecticut.png ""Third Party Administrator (Tpa) Registration" - Connecticut")