Application for Organizational Permit
and Certificate of Incorporation for Domestic Insurers--Fraternals
Chapter 614, Wis. Stat.
or Application for Certificate of Authority for
Nondomestic Fraternals Under s. 618.26, Wis. Stat.
|To view any of the listed statutes, see the Wisconsin Revisor of Statutes Web site.|
The following documents and required information and material must be completed and returned with the application for incorporation and/or license:
- In the letter of transmittal accompanying the application, please prepare a listing of the material furnished and information which was not filed and the reason for not filing. Please number all material and data filed to correspond with this instruction page.
- The statutory application fee is $400 payable to the Commissioner of Insurance.
- The Application for Lines and Classes of Business form.
- The Authority for Commissioner to Make Inquiry form.
- The Designation of Registered Agent form.
- The names, addresses and all occupations of all incorporators and proposed directors and officers for the preceding 10 years--Form A. NAIC biographicals are acceptable.
- For all corporate incorporators, their articles and bylaws, a list of the names, addresses and occupations of all directors and principal officers and, for the 3 most recent years, their annual financial statements and reports.
- The proposed articles which shall be signed and acknowledged by or on behalf of each incorporator, and the proposed bylaws.
- All agreements relating to the corporation to which any incorporator or proposed director or officer is a party.
- The amount and source of the funds available for organization expenses and the proposed arrangements for reimbursement and compensation of incorporators or other persons.
- The proposed compensation of directors and officers.
- The plan for solicitation of applications for qualifying insurance policies and for the corporation’s securities.
- The forms to be used for stock subscriptions, certificates for shares, applications for qualifying insurance policies, subscriptions for mutual bonds and contribution notes, and the forms for bonds and notes.
- The proposed capital, or the proposed minimum permanent surplus and the proposed initial surplus.
- The plan for conducting the insurance business including:
- The geographical area in which business is intended to be done in the first 5 years
- The types of insurance intended to be written in the first 5 years
- The proposed marketing methods
- A summary of the applicant’s reinsurance program on business ceded, with retentions, maximum risks, types of contracts such as pro rata, excess of loss, and any other information which may be material to this part of the applicant’s operation
- A summary of the applicant’s reinsurance assumed program with retentions, maximum risks, types of business, types of contracts to be issued, and other factors which may be material to this part of the applicant’s operations
- Brief summary of the applicant’s investment policy
- To the extent requested by the commissioner, the proposed method for the establishment of premium rates
- If part of a Holding Company System, a registration statement as provided in s. Ins 40.03, Wis. Adm. Code.
- A projection of the anticipated operating results of the corporation at the end of each of the first 5 years of operation, based on reasonable assumptions of loss experience, premiums and other income, operating expense and acquisition costs, including any assumptions used in preparing financial projections and a summary of feasibility studies or marketing surveys which support the financial projections.
- The application for a permit shall include, in addition to those things required above, a statement of the plan for fraternal activities and for the formation of a representative government under s. 614.42, Wis. Stat.
- The NAIC Company Code Application (new incorporations).
Questions about application procedures and licensing requirements should be addressed to:
Insurance Examiner Supervisor
Bureau of Financial Analysis and Examinations
APPROVAL OF POLICY FORMS
Insurers may not solicit business or market a plan unless their policy forms have been approved by the Bureau of Market Regulation of the Commissioner’s Office.
Questions about policy forms, premium rate filings, and marketing practices should be addressed to:
Bureau of Market Regulation
Division of Regulation and Enforcement
LICENSING OF AGENTS
Anyone who markets for the insurer must be licensed as an agent and be listed with the Insurance Commissioner’s office as a representative for the company.
Questions about licensing agents should be addressed to:
Agent Licensing Section
Division of Regulation and Enforcement
- MINIMUM CAPITAL AND PERMANENT SURPLUS
The Commissioner may, by rule, establish the minimum capital for a stock corporation or the minimum permanent surplus for a nonassessable mutual organized under this chapter. In the absence of such a rule, the minimum capital or minimum permanent surplus shall be $2,000,000 or such greater amount as the Commissioner specifies by order.
- INITIAL EXPANDABLE SURPLUS
A corporation organized under this chapter shall have an initial expandable surplus, after payment of all organizational expenses, of at least 50% of the minimum capital or minimum permanent surplus specified under sub. 1. or such other percentage as the Commissioner specifies by order.
- MAINTENANCE OF SOLVENCY PROVISION
Except as provided in s. 614.24 (1m), Wis. Stat., every fraternal shall contain in its laws and in each certificate of insurance it issues, a provision, to which every certificate of insurance issued by the fraternal shall be subject, that if the financial position of the fraternal becomes impaired, the board of directors or the supreme governing body may determine on an equitable basis the proportionate share of the deficiency of each member of the fraternal. The member may then either pay the member’s share of the deficiency, or accept the imposition of a lien on the certificate of insurance, to bear interest at the rate charged on policy loans under the certificate, compounded annually until paid, or may accept a proportionate reduction in benefits under the certificate. The fraternal may specify the manner of the election and which alternative is to be presumed if no election is made.
- REDUCTION OF MINIMUM SURPLUS
The Commissioner may, by order, reduce the minimum amounts of surplus required under subs. (1) and (2) if in the Commissioner’s opinion the extent and nature of providers’ contracts, financial guarantees and other support by financially sound private or public corporations, a pressing social need in a particular community for the formation of a fraternal to provide needed insurance coverage, or other special circumstances, justify the proposed reduction in the required surplus. A person who will directly compete with the proposed fraternal is aggrieved within the meaning of s. 601.62 (3) (a), Wis. Stat.
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 .
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 .
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 .
Please direct questions to: firstname.lastname@example.org (please include your name, phone number, and e-mail address).