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Louisiana Department of Insurance Forms

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Form RJ-1 Certificate of Reinsurer Domiciled in Reciprocal Jurisdiction - Louisiana PDF

Form RJ-1 Certificate of Reinsurer Domiciled in Reciprocal Jurisdiction - Louisiana
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Form COR-1 Change of Record Form (Change of Name/Trade Name) - Louisiana PDF

Form COR-1 Change of Record Form (Change of Name/Trade Name) - Louisiana
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Form CR-1 Certificate of Certified Reinsurer - Louisiana PDF

Form CR-1 Certificate of Certified Reinsurer - Louisiana
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Form PEO1 Registration to Act as a Professional Employer Organization in the State of Louisiana - Louisiana PDF

Form PEO1 Registration to Act as a Professional Employer Organization in the State of Louisiana - Louisiana
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Form 1071 Quarterly Tax Statement - Louisiana, 2022 PDF

Form 1071 Quarterly Tax Statement - Louisiana, 2022
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Form 203P Acceptance of Access to Records Request - Louisiana PDF

Form 203P Acceptance of Access to Records Request - Louisiana
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Form 1425 Military Discount Tax Credit Report - Louisiana, 2022 PDF

Form 1425 Military Discount Tax Credit Report - Louisiana, 2022
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Form 1623 Application for Resident or Non-resident Managing General Agent - Louisiana PDF

Form 1623 Application for Resident or Non-resident Managing General Agent - Louisiana
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Form 1265B Surplus Line Insurer or Other Unauthorized Insurer Policy Statement Direct Placement Tax Report - Louisiana PDF

Form 1265B Surplus Line Insurer or Other Unauthorized Insurer Policy Statement Direct Placement Tax Report - Louisiana
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Form 1068C Investment Tax Credit Report of Qualifying Assets - Louisiana, 2023 PDF

Form 1068C Investment Tax Credit Report of Qualifying Assets - Louisiana, 2023
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Form 1068E Capco Credit Notification of Sale or Transfer - Louisiana, 2022 PDF

Form 1068E Capco Credit Notification of Sale or Transfer - Louisiana, 2022
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Form 1262.1 Approved Unauthorized Insurer Producer Production Report - Alien - Louisiana, 2022 PDF

Form 1262.1 Approved Unauthorized Insurer Producer Production Report - Alien - Louisiana, 2022
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Form 1265 B Surplus Line Insurer or Other Unauthorized Insurer Policy Statement Direct Placement Tax Report - Louisiana PDF

Form 1265 B Surplus Line Insurer or Other Unauthorized Insurer Policy Statement Direct Placement Tax Report - Louisiana
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Form 1262.1 Approved Unauthorized Insurer Producer Production Report Foreign - Louisiana, 2020 PDF

Form 1262.1 Approved Unauthorized Insurer Producer Production Report Foreign - Louisiana, 2020
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Form 1262.1 Approved Unauthorized Insurer Producer Production Report Alien - Louisiana, 2020 PDF

Form 1262.1 Approved Unauthorized Insurer Producer Production Report Alien - Louisiana, 2020
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Form 1566 ENTITY Application for Entity Navigator License - Louisiana PDF

Form 1566 ENTITY Application for Entity Navigator License - Louisiana
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Form 1566 INDIVIDUAL Application for Individual Navigator License - Louisiana PDF

Form 1566 INDIVIDUAL Application for Individual Navigator License - Louisiana
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Application to Act as a Utilization Review Organization in the State of Louisiana - Louisiana PDF

Application to Act as a Utilization Review Organization in the State of Louisiana - Louisiana
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Application to Act as a Third Party Administrator in the State of Louisiana - Louisiana PDF

Application to Act as a Third Party Administrator in the State of Louisiana - Louisiana
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Application for Business Entity Insurance Producer, Consultant, Public or Claims Adjuster License - Louisiana PDF

Application for Business Entity Insurance Producer, Consultant, Public or Claims Adjuster License - Louisiana
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Application for New or Renewal Managing General Agent Registration - Louisiana PDF

Application for New or Renewal Managing General Agent Registration - Louisiana
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Application to Act as a Discount Medical Plan in the State of Louisiana - Louisiana PDF

Application to Act as a Discount Medical Plan in the State of Louisiana - Louisiana
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Application for Resident or Nonresident Reinsurance Intermediary Broker or Manager - Louisiana PDF

Application for Resident or Nonresident Reinsurance Intermediary Broker or Manager - Louisiana
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Application for Individual Insurance Producer, Consultant, Public or Claims Adjuster License - Louisiana PDF

Application for Individual Insurance Producer, Consultant, Public or Claims Adjuster License - Louisiana
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Application for Business Entity Insurance Producer, Consultant, Public or Claims Adjuster License - Louisiana PDF

Application for Business Entity Insurance Producer, Consultant, Public or Claims Adjuster License - Louisiana
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Request for Pre-application Eligibility Determination - Louisiana PDF

Request for Pre-application Eligibility Determination - Louisiana
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Application Verifying Eligibility as Surplus Lines Insurer in the State of Louisiana - Louisiana PDF

Application Verifying Eligibility as Surplus Lines Insurer in the State of Louisiana - Louisiana
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Application to Act as a Captive Insurer in the State of Louisiana - Louisiana PDF

Application to Act as a Captive Insurer in the State of Louisiana - Louisiana
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Request for Consent or a Waiver Pursuant to La. R.s. 22:1554(A)(18) - Louisiana PDF

Request for Consent or a Waiver Pursuant to La. R.s. 22:1554(A)(18) - Louisiana
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Application to Act as a Specialty Insurer in the State of Louisiana - Louisiana PDF

Application to Act as a Specialty Insurer in the State of Louisiana - Louisiana
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Application for Registration of a Risk Purchasing Group in the State of Louisiana - Louisiana PDF

Application for Registration of a Risk Purchasing Group in the State of Louisiana - Louisiana
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Application to Act as a Workers' Compensation Self-insurance Fund in the State of Louisiana - Louisiana PDF

Application to Act as a Workers' Compensation Self-insurance Fund in the State of Louisiana - Louisiana
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Application to Act as a Utilization Review Organization in the State of Louisiana - Louisiana PDF

Application to Act as a Utilization Review Organization in the State of Louisiana - Louisiana
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Application for a Certificate of Authority as a Louisiana Domiciled Insurer - Louisiana PDF

Application for a Certificate of Authority as a Louisiana Domiciled Insurer - Louisiana
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Application for Health Maintenance Organization License in Louisiana - Louisiana PDF

Application for Health Maintenance Organization License in Louisiana - Louisiana
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Application for Dissolution of a Louisiana Domiciled Insurer - Louisiana PDF

Application for Dissolution of a Louisiana Domiciled Insurer - Louisiana
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Application to Act as a Captive Insurer in the State of Louisiana - Louisiana PDF

Application to Act as a Captive Insurer in the State of Louisiana - Louisiana
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Application to Act as a Pharmacy Services Administrative Organization in the State of Louisiana - Louisiana PDF

Application to Act as a Pharmacy Services Administrative Organization in the State of Louisiana - Louisiana
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Request for Commissioner to Hold Deposit on Behalf of Insurer - Louisiana PDF

Request for Commissioner to Hold Deposit on Behalf of Insurer - Louisiana
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Affidavit of Loss of Original Certificate of Authority or Approval - Louisiana PDF

Affidavit of Loss of Original Certificate of Authority or Approval - Louisiana
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