Alphabetical List
| Title |
Form # |
| Affidavit for Lost Certificate of Authority |
2361 |
| Amended Certificate of Authority Application |
3305
Word | PDF |
| Instructions |
| Application
for Reservation of Name |
|
| Certificate of Authority Application |
| Domestic
Home Protection |
|
| Domestic
Insurer |
|
| Foreign
or Alien Home Protection Insurer |
|
| Health
Care Service Contractor (HCSC) |
|
| Insurance
Companies |
|
|
|
|
| Health Care Service Contractor Bond |
3117 |
| Home Protection Insurer Bond |
2805 |
| Organizational Bond |
3094 |
| Permit to Organize Insurer with or without Capital Stock
Application |
3106
Word |
PDF |
| |
| Change of Registered Office and Registered Agent by Insurer |
3310 |
| Instructions |
| Designation of Registered Office and Registered Agent by Insurer |
3309 |
| External Review Referral Request |
3430 |
| Forms A through D |
| Statement Regarding the Acquisition of Control of Merger
with a Domestic Insurer |
Form
A |
| Insurance Holding Company System Annual Registration |
Form
B |
| Summary of Registration Statement |
Form
C |
| Prior Notice of a Transaction |
Form
D |
| |
| Form I.S.S. and instructions |
2035
Word |
PDF |
| Form C.S.S. and instructions |
2036
Word |
PDF |
| Health
Benefit Plan Report |
|
| Instruction
Guidelines |
| Health
Enrollment Report Form |
|
| Life Settlement Provider |
| Disclosure Statement for Life Settlement Contracts (Provider) |
3012 |
| Application for License as Life Settlement Provider |
3015
Word |
PDF |
| Life Settlement Broker Appointment/Affiliation Notice |
3025 |
| Life Settlement Provider Bond |
3359 |
| |
| Legal Expense Organization |
| Certificate of Registration |
2167 |
| Instructions |
| Change of Registered Office or Registered Agent |
2169
Word |
PDF |
| Designation of Registered Office or Registered Agent |
2168 |
| Financial Statement |
2164
Word |
PDF |
| Legal Expense Insurance List of Sales & Marketing
Representatives |
2166
Word |
PDF
|
| Qualifying Bond for Legal Expense |
2165
Word |
PDF |
| Renewal of Certificate of Registration for Legal Expense
Organization Application |
2170 |
| |
| Medical/Dental Negligence Claim Report |
1962 |
| Medical Discount Plan Organizations |
| Discount Medical Plan Organization Application |
4782
Word |
PDF |
| Discount Medical Plan Organization Renewal |
4793
Word |
PDF |
| Appointment of Insurance Commissioner for Legal Service |
4779
Word |
PDF |
| |
| Multiple Employer Welfare Arrangement |
| Certificate of Multiple Employer Welfare Arrangement Application |
3132
Word |
PDF |
| Multiple Employer Welfare Arrangement Bond |
3630
Word |
PDF |
| |
| Obligors |
| Obligor of Home Service Agreement Bond |
3443
Word |
PDF |
| Obligor of Service Contracts Registration Application |
2851
Word |
PDF |
| Instructions |
| |
| OIGA Assessment Recoupment |
2007 |
2006
|
| Oregon Special Schedule P |
3112
Excel |
PDF |
| For Insurers authorized to write workers' compensation |
| Patient Protection Reporting Forms |
| Grievance Annual Report |
3241
Word |
PDF |
| Quality Assessment Annual Summary |
3239
Word |
PDF |
| Network Adequacy Annual Summary |
3237
Word |
PDF |
| Utilization Review Annual Summary |
3238
Word |
PDF |
| |
Prompt Payment Data Report
For health insurers and health care service
contractors |
3431 |
| Instructions |
| Rating Organizations |
| Rating Organization License Application |
3246
Word |
PDF |
| Rating Organization Amended License Application |
3247
Word |
PDF |
| |
| Security Deposit |
| Security Deposit Release General Request |
3461
Word |
PDF |
| Security Deposit Release Request For Workers' Compensation |
2944
Word |
PDF |
| |
| Tax Forms |
| Excise |
|
| Amended Tax Return |
4760
PDF |
Excel |
| Ocean Marine |
PDF |
Excel |
| Insurance Tax Return |
3646
PDF |
Excel |
| Risk Retention Tax |
0898
PDF |
Excel |
| Surplus Lines Licensee Affidavit for Purchasing Groups |
3928
Word |
PDF |
| |
| Vehicle Theft Protection |
| Warrantor of Vehicle Protection Product Registration
Application |
4778
Word |
PDF |
| Warrantor of Vehicle Protection Product Renewal Form |
4785
Word |
PDF |
| |
