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Application for insurance companies applying as a New Hampshire domestic.

New Hampshire Domestic Uniform Certificate of Authority Application.

Please note that before submitting the application, the Company needs to meet with the Department to go over its business plan.

The following are the filing requirements for a domestic company for admission in the State of New Hampshire:

  • UCAA Application (Primary Application). Send 1 original, Chapter 401 - List of New Hampshire Paragraphs Adobe Acrobat Reader Symbol If applying for paragraph VIII, Other Casualty Risks, refer to the NAIC Uniform P&C Product Coding Matrix.
  • $1,000.00 Application Fee. Make check payable to "Treasurer, State of New Hampshire." **Fee is non-refundable.
  • New Hampshire Guaranty Association information (Life Forms) (P&C Forms, Guaranty Assoc. Acknowledgement) Adobe Acrobat Reader Symbol. Please include proof of payment, made to the New Hampshire Guaranty Association (proof of payment: cancelled check or a letter from the association).
  • Insurance Company formed as a New Hampshire Corporation, by ten or more incorporates, all of whom must be residents of the state. RSA 401:2
  • Three original copies of the proposed charter must be submitted to the Insurance Commissioner for approval. RSA 401:6
  • Three original copies of the by-laws and articles of incorporation must be submitted. A $100.00 check needs to be submitted with the articles for the Secretary of State’s fee. Make check payable to the NH Secretary of State and submit to the New Hampshire Insurance Department.
  • Submit a listing of the applicant’s legal, accounting and actuarial representatives by name and address.
  • Submit evidences of fidelity bond coverage of all officers and employees entrusted with the handling of funds for the applicant.
  • Security Deposit information

Please forward the above to the New Hampshire Insurance Department, Financial Regulation Division.

If you have any questions, please contact Mary Verville or Patricia Gosselin

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New Hampshire Insurance Department | 21 South Fruit Street, Suite 14 | Concord, NH 03301
Phone 603.271.2261 | Fax 603.271.1406 | Consumer Hotline 1.800.852.3416

Copyright © State of New Hampshire, 2007