Rate/Forms Forms and Office Locations – Government Agency in Utah

1 - 20 of 29 forms

Form Title	Topics
APCD Self-Funded Employee Health Plan Opt-In Form
Attachment A 31A-23a-501 Required Form for Utah Large Employers
Clearance Letter Request
Consumer Complaint Form Cover Sheet
Dual Licensee Request for Approval for the Provision of a Title Insurance Product or Service
FORM B INSURANCE HOLDING COMPANY SYSTEM ANNUAL REGISTRATION STATEMENT
FORM C SUMMARY OF CHANGES TO REGISTRATION STATEMENT
FORM D PRIOR NOTICE OF A TRANSACTION
FORM E PRE-ACQUISITION NOTIFICATION FORM REGARDING THE POTENTIAL COMPETITIVE IMPACT OF A PROPOSED MERGER OR ACQUISITION BY A NON-DOMICILIARY INSURER DOING BUSINESS IN THIS STATE OR BY A DOMESTIC INSURER
FORM F ENTERPRISE RISK REPORT
Independent Review Request form
Individual/Agency Change Request Form
Insurer Loss Costs Multiplier Filing Form
MEDICARE SUPPLEMENT REFUND CALCULATION FORM
Motor Club Renewal — 2025
Notice of Addition or Termination of Designee to Agency License
Office Report Form
PRODUCER AGREEMENT AND COMPENSATION DISCLOSURE
REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIO SINCE INCEPTION FOR GROUP POLICIES
STATEMENT REGARDING THE ACQUISITION OF CONTROL OF OR MERGER WITH A DOMESTIC INSURER

Rate/Forms