Marcia Hultman

Cabinet Secretary

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Division of Insurance


Company Filings and Forms

The forms are available in Adobe PDF format unless otherwise noted.

For each listing, if applicable, the specific chapter of South Dakota Codified Law (SDCL) associated with the requirement is cited.

Company Type Form SDCL
  Application for Licensure or Registration (UCAA) (NAIC website)  
  UCAA Corporate Amendments Application Information webpage  
Life, Accident, Health Insurers Checklist for Filings in 2017 58-6
Property Casualty Checklist for Filings in 2017 58-6
Health Entities Checklist for Filings in 2017 58-6
Fraternal Companies Checklist for Filings in 2017 58-6
Title Companies Checklist for Filings in 2017 58-6
Unauthorized Insurers Writing Business in SD Checklist for Filings  58-6
Holding Company Form A - Electronic Version 58-5A
Holding Company Form B - Electronic Version 58-5A
Holding Company Form C - Electronic Version 58-5A
Holding Company Form D - Electronic Version 58-5A
Holding Company Form E - Electronic Version 58-5A
Holding Company Form F - Electronic Version 58-5A
Health Insurance Companies 2017 Market Survey-Covered Lives Report Form (Adobe PDF format)
Due date: May 15, 2017.

(A Word .doc version of the form can be requested by email to sdinsurancereports@state.sd.us.)
Life & Health Publication Statement
(See list of companies required to complete the Publication Statement.)
58-6-76
Fire & Casualty Publication Statement
(See list of companies required to complete the Publication Statement.)
58-6-76
Property Casualty, Life/Health, Title             Statement of Deposit 58-7
Health Maintenance Organization Statement of Deposit 58-7
Risk Retention Group Registration Packet 58-6A
Risk Purchasing Group Registration Packet 58-6A
Accredited or Qualified Reinsurer Registration Packet 58-14
Company Appointments and Terminations  Producer or Business Entity Multi Appointment Form  58-30
Company Appointments and Terminations  Notice of Termination of Company Appointment  58-30
Insurance Companies Premium Tax Return Filing Information webpage  
Insurance Companies Premium Tax Refund Form 10-55A-6
Health Rate & Form Filing Requirements (webpage)
Property Casualty Rate & Form Filing Requirements (webpage)
Captive Insurance Companies Captive Insurance Company Application  
Farm Mutuals Annual Statement & Tax Return  
  Medical Malpractice Reporting (webpage)  

Contact the Division of Insurance