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For Companies > Renewal Applications > TPA License Renewal
Third Party Administrator License Renewal Application
 

The following items are required in order to renew a Third Party Administrator license:

Please review RSA 402-H and Ins 2300.

Due March 1st

  • Application Form Adobe Acrobat Reader Symbol
  • $200 Renewal Fee ($100 Audited Financial Report Fee & $100 Annual License Renewal Fee)

Due June 1st

  • Audited Financial Statement - CPA

(Financial statement must be compiled in a manner consistent with generally accepted accounting principles (GAAP).  The financial statement must be accompanied by an opinion by an independent accounting firm representing that the financial statement was prepared in a manner consistent with GAAP and accurately reflects the financial condition of the entity)

Please make check payable to “New Hampshire Insurance Department.”  One check in the amount of $200 needs to be submitted with the updated application form.

The completed application package and filing fee should be directed 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

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