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CA Department of Insurance
CA Department of Insurance
CA Department of Insurance

Certificate of Authority Application Forms

The California Department of Insurance's (CDI) Certificate of Authority Application forms are now available in Adobe's Portable Document Format (PDF). The Word documents may be downloaded to your computer. To view and complete these pdf forms on your browser, you must have Adobe Acrobat Reader on your computer. A free copy of the Adobe Acrobat Reader can be downloaded from our Free Document Readers web page.

Additional forms may need to be added or revised periodically, so keep checking back. Please submit the completed forms to:

California Department of Insurance
Corporate Affairs Bureau
1901 Harrison Street, 6th Floor
Oakland, CA 94612

We also request, in addition to the two hard copies, that you submit an electronic copy of the application and supporting documents to CAB-SF-Intake@insurance.ca.gov.  Please note we do not accept password protected emails or links.  

If you have any questions about our admission process, please contact the CDI's Corporate Affairs Bureau by emailing your questions to the Bureau's email address noted above, or by calling (415) 538-4035. We recommend you contact the CDI with any questions prior to submitting your application.

 

Certificate of Authority Application Checklist 

Item #1: Admission to California
Item #3: Sample Plan of Operation Verification Form
Item #7: Individual Affidavit
Item #8: Organizational Affidavit
Item #10: Delegation of Insurer Functions Checklist
Item #12: Questionnaire
Item #16: Appointment of Agent for Service of Process 
  Appointment of an individual with a California address (not a Post Office Box Number),
preferably with an established place of business, who can be readily located and served
with notices, legal process, and papers is mandatory. Date of agent's acceptance must
be on or after the appointment/execution date.
Item #17: Special Power of Attorney to Appoint and Certify Agents
Item #18: Letter of Credit for Workers' Compensation Deposit
Item #18: Workers' Compensation Deposit Trust and Security Agreement
Item #20: Authorization for Disclosure of Financial Records
Item #26: Certificate of Organization, Capital and Assets
Item #33: Reinsurance Checklist for Life Companies
Item #33: Reinsurance Checklist for Property and Casualty Companies
Item #33: Treaty Summary Form for Property & Casualty Insurers
Item #35: Subscription Agreement - California Life & Health Insurance Guarantee Association
Item #36: Subscription Agreement - California Insurance Guarantee Association
Item #37: Subscription Agreement - California Automobile Assigned Risk Plan
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