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For Companies > Licensing and Approvals for Prospective Companies > Applications > TPA Amendment
Amendment Application for Licensed Third Party Administrators Amending License
 

The following items must be completed to amend the Third Party Administrator license (please note that only those items listed below that have changed need to be submitted):

  • Amended Application Adobe Acrobat Reader Symbol
  • $25.00 Amendment Fee – Make check payable to "Treasurer, State of NH." **Fee is non-refundable.
  • Surety Bond Form Adobe Acrobat Reader Symbol
  • NAIC Biographical Form
  • Amended By-Laws
  • Amended Articles of Incorporation
  • Certificate of Good Standing from State of Domicile’s Secretary of State’s office and State of New Hampshire’s Secretary of State’s office (603) 271-3242.
  • Return the current original New Hampshire Certificate of Authority.

Please mail information to the New Hampshire Insurance Department, Financial Regulation Division.

If you have any questions please contact Diane Cygan .

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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