|
Numeric Listing
|
| Form # |
Title |
1962
Word | PDF |
Medical/Dental Negligence Claim Report |
2035
Word | PDF |
Form I.S.S. and instructions |
2036
Word | PDF |
Form C.S.S. and instructions |
2164
Word | PDF |
Financial Statement for Legal Expense Organization |
2165
Word | PDF |
Qualifying Bond for Legal Expense |
2166
Word | PDF |
Legal Expense Insurance List of Sales & Marketing Representatives |
| 2167 |
Application for Certificate of Registration for Legal Expense Organization |
| Instructions |
| 2168 |
Designation of Registered Office and Registered Agent by Legal Expense Organization |
2169
Word |
PDF |
Change of Registered Office and Registered Agent by Legal Expense Organization |
| 2170 |
Application for Renewal of Certificate of Registration for Legal Expense Organization |
| 2361 |
Affidavit for Lost Certificate of Authority |
| 2805 |
Home Protection Insurer Bond |
2851
Word |
PDF |
Obligor of Service Contracts Registration Application |
| Instructions |
2944
Word | PDF |
Security Deposit Release Request For Workers' Compensation |
| 3094 |
Organizational Bond |
| 3095 |
Oregon Biographical Affidavit |
3106
Word | PDF |
Application for Permit to Organize Insurer with or without Capital Stock |
3112
Excel | PDF |
Oregon Special Schedule P |
| For Insurers authorized to write workers' compensation |
| 3117 |
Health Care Service Contractor Bond |
3237
Word | PDF |
Network Adequacy Annual Summary |
3238
Word | PDF |
Utilization Review Annual Summary |
3239
Word | PDF |
Quality Assesment Annual Summary |
3241
Word | PDF |
Grievance Annual Report |
3246
Word | PDF |
Rating Organization License Application |
3247
Word | PDF |
Rating Organization Amended License Application |
3305
Word | PDF |
Application for Amended Certificate of Authority |
| Instructions |
| 3309 |
Designation of Registered Office and Registered Agent by Insurer |
| 3310 |
Change of Registered Office or Registered Agent by Insurer |
| Instructions |
| 3359 |
Life Settlement Provider Bond |
| 3430 |
External Review Referral Request |
| 3431 |
Prompt Payment Data Report
Health insurers and health care service contractors |
| Instructions |
3443
Word | PDF |
Obligor of Home Service Agreement Bond |
3461
Word | PDF |
Security Deposit Release General Request |
| |
Application for Certificate of Authority |
| Domestic Home Protection Insurer |
| Domestic Insurer |
| Foreign Home Protection Insurer |
| Health Care Service Contractor (HCSC) |
Insurance Companies
|
| |
Application for Reservation of Name |
3630
Word | PDF |
Multiple Employer Welfare Arrangement Bond |
3928
Word | PDF
|
Surplus Lines Licensee Affidavit for Purchasing Groups |
