Florida Department of State and Division of Library and Information Services
Notice: 27890039
Final Adopted Version in F.A.C.
Department: DEPARTMENT OF FINANCIAL SERVICES
Division: OIR – Insurance Regulation
Chapter: APPLICATION PROCEDURES FOR COMPANIES SEEKING TO DO BUSINESS IN FLORIDA

VIEW NOTICE

Overview
RULE:
69O-136.100   Forms Incorporated by Reference
RULE FILE DATE: 12/18/2023
RULE EFFECTIVE DATE: 1/7/2024
HISTORY NOTES: Rulemaking Authority 624.308(1), 624.413(1), 628.461(13), 628.4615(15), 628.535 FS. Law Implemented 624.307(1), 624.34, 624.404, 624.413, 624.424(6), 624.501, 624.5091, 626.9928, 628.451, 628.461, 628.4615, 628.471, 628.801, 634.252, 634.3073, 634.4085, 636.065, 641.255, 641.416, 642.032, 651.024, 651.0245 FS. History–New 7-21-22, Amended 1-7-24.
OVERSIGHT COMMITTEE: Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)
RELATED COURT CASES: Division of Administrative Hearings
FEDERAL RULES
AND REGULATIONS: 		Electronic Code of Federal Regulations
HOW TO LINK TO
THIS NOTICE: 		http://www.flrules.org/gateway/ruleno.asp?id=69O-136.100&Section=0
REFERENCE MATERIALS: Ref-14435 Service of Process Consent & Agreement
Ref-14436 Application for Acquisition of Controlling Stock, Ownership Interest, Assets, or Control of a Florida Specialty Insurer; Merger or Consolidation
Ref-14437 Instructions for Furnishing Background Investigative Reports
Ref-14438 Application for Acquisition of Controlling Stock of a Florida Domestic Insurer
Ref-14439 Fingerprint Payment and Submission Procedure
Ref-14441 Uniform Certificate of Authority Application (UCAA) Biographical Affidavit
Ref-14442 Disclaimer of Control - Individual
Ref-14443 Disclaimer of Control - Entity
Ref-14444 Uniform Certificate of Authority Application (UCAA) Uniform Consent to Service of Process
Ref-14445 Disclaimer of Control – Investment Companies
Ref-14446 Management Information Form
Ref-14448 UCAA Proforma Financial Statements, Property and Casualty Insurance Company
Ref-14450 UCAA Proforma Financial Statements, Health
Ref-14593 UCAA Proforma Financial Statements, Title Insurance Company
Ref-16192 OIR-B1-PCR3, Filing requirements Advisory Organization
Ref-16193 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
Ref-16194 OIR-C1-0500, UCAA Biographical Affidavit Addendum Blank
Ref-16195 OIR-C1-0501, UCAA Biographical Affidavit Addendum Education
Ref-16196 OIR-C1-0502, UCAA Biographical Affidavit Addendum Employment
Ref-16197 OIR-C1-0503, UCAA Biographical Affidavit Addendum General
Ref-16198 OIR-C1-0504, UCAA Biographical Affidavit Addendum Licenses
Ref-16199 OIR-C1-0505, UCAA Biographical Affidavit Addendum Professional
Ref-16200 OIR-C1-0506, UCAA Biographical Affidavit Addendum Residence
Ref-16201 OIR-C1-0507, UCAA Biographical Affidavit Addendum Societies
Ref-16202 OIR-C1-0508, “Uniform Certificate of Authority Application (UCAA) Affidavit of Lost Certificate of Authority
Ref-16203 OIR-C1-0509, Uniform Certificate of Authority Application (UCAA) Biographical Affidavit Cover Letter Holding Company Structure
Ref-16206 OIR-C1-0510, “Uniform Certificate of Authority Application (UCAA) Corporate Amendments Application Application to Amend Certificate of Authority
Ref-16208 OIR-C1-0511, Uniform Certificate of Authority Application (UCAA) Corporate Amendments Application Checklist for Corporate Amendments Application Only
Ref-16210 OIR-C1-0512, Uniform Certificate of Authority Application Questionnaire for Adding or Deleting Lines of Business to an Existing Certificate of Authority
Ref-16212 OIR-C1-0520, Uniform Certificate of Authority Application (UCAA) Primary Application Checklist for Primary Application Only
Ref-16213 OIR-C1-0521, Uniform Certificate of Authority Application (UCAA) Primary Application
Ref-16214 OIR-C1-0522, “Uniform Certificate of Application (UCAA) Change of Mailing Address/Contact Notification Form
Ref-16216 OIR-C1-513, Application for Registration as a Risk Retention Group
Ref-16217 OIR-C1-515, Application for Registration as a Risk Purchasing Group
Ref-16227 OIR-C1-845, Application for Certificate of Authority Commercial Self-Insurance Fund
Ref-16228 OIR-C1-908, Application for Permit Domestic Reciprocal Insurer
Ref-16229 OIR-C1-916, Application for Eligibility as a Surplus Lines Insurer
Ref-16230 OIR-C1-1413, Uniform Certificate of Authority Application (UCAA) Expansion Application
Ref-16231 OIR-C1-1414, Uniform Certificate of Authority Application (UCAA) Expansion Application Checklist For Expansion Application Only
Ref-16232 Form OIR-C1-1416, Uniform Certificate of Authority Application (UCAA) Lines of Insurance
Ref-16233 OIR-C1-1422, Uniform Certificate of Authority Application Questionnaire
Ref-16234 OIR-C1-1424, Uniform Certificate of Authority Application
Ref-16235 OIR-C1-1522, Primary Application Florida Specific Information
Ref-16237 OIR-C1-2069, Letter of Notification
Ref-16238 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
Ref-16239 OIR-C1-PCR1, Application for License Rating Organization


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