Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-136 - APPLICATION PROCEDURES FOR COMPANIES SEEKING TO DO BUSINESS IN FLORIDA › Section 69O-136.100 - Forms Incorporated by Reference

Current through Reg. 50, No. 138; July 16, 2024
(1) The
				forms in subsection (2) of this rule are available and may be printed from the
				Office of Insurance Regulation's website:
https://www.floir.com/iportal
, and
				are hereby incorporated by reference.
(2)
(a)
				Form OIR-B1-PCR3, "Filing requirements Advisory Organization," effective 7/23,
				hereby incorporated by reference and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16192
,
				electronically at
https://www.floir.com/iportal
.
(b) Form OIR-B2-1093, "Small Employer
				Carrier's Application to Become a Risk Assuming Carrier or a Reinsuring
				Carrier, as Required by Section
				627.6699(9),
				Florida Statutes," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16193
.
(c) Forms OIR-C1
1. Form OIR-C1-0500, "UCAA Biographical
				Affidavit Addendum Blank," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16194
;
2. Form OIR-C1-0501, "UCAA Biographical
				Affidavit Addendum Education," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16195
;
3. Form OIR-C1-0502, "UCAA Biographical
				Affidavit Addendum Employment," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16196
;
4. Form OIR-C1-0503, "UCAA Biographical
				Affidavit Addendum General," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16197
;
5. Form OIR-C1-0504, "UCAA Biographical
				Affidavit Addendum Licenses," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16198
;
6. Form OIR-C1-0505, "UCAA Biographical
				Affidavit Addendum Professional," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16199
;
7. Form OIR-C1-0506, "UCAA Biographical
				Affidavit Addendum Residence," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16200
;
8. Form OIR-C1-0507, "UCAA Biographical
				Affidavit Addendum Societies," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16201
;
9. Form OIR-C1-0508, "Uniform Certificate of
				Authority Application (UCAA) Affidavit of Lost Certificate of Authority,"
				effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16202
;
10. Form OIR-C1-0509, "Uniform Certificate of
				Authority Application (UCAA) Biographical Affidavit Cover Letter Holding
				Company Structure," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16203
;
11. Form OIR-C1-0510, "Uniform Certificate of
				Authority Application (UCAA) Corporate Amendments Application Application to
				Amend Certificate of Authority," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16206
;
12. Form OIR-C1-0511, "Uniform Certificate of
				Authority Application (UCAA) Corporate Amendments Application Checklist for
				Corporate Amendments Application Only," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16208
;
13. Form OIR-C1-0512, "Uniform Certificate of
				Authority Application Questionnaire for Adding or Deleting Lines of Business to
				an Existing Certificate of Authority," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16210
;
14. Form OIR-C1-0520, "Uniform Certificate of
				Authority Application (UCAA) Primary Application Checklist for Primary
				Application Only" effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16212
;
15. Form OIR-C1-0521, "Uniform Certificate of
				Authority Application (UCAA) Primary Application" effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16213
;
16. Form OIR-C1-0522, "Uniform Certificate of
				Application (UCAA) Change of Mailing Address/Contact Notification Form,"
				effective 7/23,
http://www.flrules.org/Gateway/reference.asp?No=Ref-16214
;
17. Form OIR-C1-144, "Service of Process
				Consent & Agreement," effective 6/04, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-14435
;
18. Form OIR-C1-448, "Application for
				Acquisition of Controlling Stock, Ownership Interest, Assets, or Control of a
				Florida Specialty Insurer; Merger or Consolidation," effective 7/21, available
				at
http://www.flrules.org/Gateway/reference.asp?No=Ref-14436
;
19. Form OIR-C1-513, "Application for
				Registration as a Risk Retention Group," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16216
;
20. Form OIR-C1-515, "Application for
				Registration as a Risk Purchasing Group," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16217
;
21. Form OIR-C1-845, "Application for
				Certificate of Authority Commercial Self-Insurance Fund," effective 7/23,
				available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16227
;
22. Form OIR-C1-905, "Instructions for
				Furnishing Background Investigative Reports," effective 6/20, hereby
				incorporated by reference and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-14437
;
23. Form OIR-C1-908, "Application for Permit
				Domestic Reciprocal Insurer," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16228
;
24. Form OIR-C1-916, "Application for
				Eligibility as a Surplus Lines Insurer," effective 7/23, available at
www
.
http://www.flrules.org/Gateway/reference.asp?No=Ref-16229
;
25. Form OIR-C1-918, "Application for
				Acquisition of Controlling Stock of a Florida Domestic Insurer," effective
				7/21, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14438
;
26. Form OIR-C1-938, "Fingerprint Payment and
				Submission Procedure," effective 6/20, hereby incorporated by reference and
				available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14439
;
27. Form OIR-C1-1413, "Uniform Certificate of
				Authority Application (UCAA) Expansion Application," effective 7/23, available
				at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16230
;
28. Form OIR-C1-1414, "Uniform Certificate of
				Authority Application (UCAA) Expansion Application Checklist For Expansion
				Application Only," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16231
;
29. Form OIR-C1-1416, "Uniform Certificate of
				Authority Application (UCAA) Lines of Insurance," effective 1/20, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16232
;
30. Form OIR-C1-1422, "Uniform Certificate of
				Authority Application Questionnaire," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16233
;
31. Form OIR-C1-1423, "Uniform Certificate of
				Authority Application (UCAA) Biographical Affidavit," effective 12/20, hereby
				incorporated by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14441
32. Form OIR-C1-1424, "Uniform Certificate of
				Authority Application," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16234
;
33. Form OIR-C1-1467, "Disclaimer of Control
				- Individual," effective 7/21, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-14442
34. Form OIR-C1-1468, "Disclaimer of Control
				- Entity," effective 7/21, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14443
;
35. Form OIR-C1-1522, "Primary Application
				Florida Specific Information," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16235
;
36. Form OIR-C1-1524, "Uniform Certificate of
				Authority Application (UCAA) Uniform Consent to Service of Process," effective
				12/19, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14444
;
37. Form OIR-C1-1654, "Determination of
				Eligibility to Operate as an Alien Insurer in Florida Pursuant to Section
				624.402(9),
				Florida Statutes," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16236
;
38. Form OIR-C1-2069, "Letter of
				Notification," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16237
;
39. Form OIR-C1-2176, "Letter of
				Notification/Registration to Operate as a Non-US Based (Alien) Insurer (also
				referred to as "Offshore Insurer") in Florida Pursuant to Section
				624.402(8),
				Florida Statutes," effective 7/23, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16238
;
40. Form OIR-C1-2211, "Disclaimer of Control
				- Investment Companies," effective 7/21, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14445
;
41. Form OIR-C1-2221, "Management Information
				Form," effective 6/20, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14446
;
42. Form OIR-C1-PCR1, "Application for
				License Rating Organization," effective 7/23, hereby incorporated by reference
				and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16239
;
				and
43. Form OIR-C1-PCR2, "License
				Renewal Rating Organization," effective 7/23, hereby incorporated by reference
				and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16239
,
				filed electronically at
https://www.floir.com/iportal
.
(d) Forms OIR-D0
1. Form OIR-D0-896, "UCAA Proforma Financial
				Statements, Property and Casualty Insurance Company," effective 1/19, available
				at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14448
;
2. Form OIR-D0-904, "UCAA Proforma Financial
				Statements, Life & Health Insurer," effective 1/19, available at
www.flrules.org/14449
;
3. Form OIR-D0-2119, "UCAA Proforma Financial
				Statements, Title Insurance Company," effective 1/19, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14593
;
				and
4. Form OIR-D0-2165, "UCAA
				Proforma Financial Statements, Health," effective 1/19, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-14450
.