Application for A Limited Certificate of Authority
Warranty Plan
Chapter Ins 15, Wis. Adm. Code

Note: The following address is a link to the administrative code in pdf format:
http://www.legis.state.wi.us/rsb/code/ins/

To link to chapters in the administrative code, add insxxx.pdf to the end of the address. xxx represents the chapter number in three digits (003 for chapter 3).

The following are documents which must be completed and returned with the Application for Limited Certificate of Authority for a Warranty Plan. Any questions about the application should be directed to Mr. Karl Albert (608-264-6236 or karl.albert@wisconsin.gov) or Ms. Kristin Forsberg (608-266-9896 or kristin.forsberg@wisconsin.gov).

Also included is information detailing the procedures for submitting the warranty contracts for approval. All warranty contracts must be approved before the certificate of authority will be issued. Any questions about the policy form procedures should be directed to Ms. Ellen Vigil at (608) 267-1234.

Please note that Warranty Plan Administrators as defined in s. Ins 15.01 (4) (f), Wis. Adm. Code, must obtain a limited certificate of authority as a warranty plan.

No application will be considered completed until all items on the application form have been completed and all required forms have been completed, filed, and approved.


Application Packet Forms

The application packet forms are available to be downloaded below. Note, however, that you will need an Adobe Acrobat Reader to view or print the application forms, which you can download at no cost from Adobe .

Application Packet Forms (opens in new window)


Wisconsin Insurance Laws and Regulations


Designation of Registered Agent for Service of Process

A Designation of Registered Agent for Service of Process (OCI 12-014) form is available to be downloaded below. Note, however, that you will need an Adobe Acrobat Reader to view or print the application, which you can download at no cost from Adobe .

Designation of Registered Agent for Service of Process (opens in new window)
Fill and Print Version (opens in new window)


Warranty Contract Submission Instructions and Forms

The instructions and forms for filing the warranty contracts for approval are available to be downloaded below, under the first two items under the heading "Policy Form Filing Instructions and Forms." Note, however, that you may need an Adobe Acrobat Reader to view or print the forms, which you can download at no cost from Adobe .

Policy Form Filing Instructions and Forms


NAIC Company Code Application

A link to the NAIC Company Code Application form is provided below for your convenience. Note, however, that you will need an Adobe Acrobat Reader to view or print the application form, which you can download at no cost from Adobe . Warranty Plans need not file financial data with the NAIC, but are required to obtain a NAIC Company Code. This assists with the collection of demographic statistics by state and federal authorities. Once the NAIC Company Code is issued, it remains in force for the entire existence of the Warranty Plan.

NAIC Company Code Application (opens in new window)


Please direct questions to: ocifinancial@wisconsin.gov (please include your name, phone number, and e-mail address).