Department of Labor and Regulation

Title - Division of Insurance e-mail the Division of Insurance

Filings and Forms

The following documents are provided in Adobe .pdf format* unless otherwise noted.

Company Type Form South
Dakota
Codified
Law
Life, Accident, Health Insurers Checklist for Filings in 2012 58-6
Property Casualty Checklist for Filings in 2012 58-6
Health Entities Checklist for Filings in 2012 58-6
Fraternal Companies Checklist for Filings in 2012 58-6
Title Companies Checklist for Filings in 2012 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
Health Insurance Companies Market Survey 2012 - Choose [Microsoft Word format] or [Adobe .pdf format]*

Companies Required to Complete Publication Statement
  (See forms below.)

 58-6-76
Life & Health Publication Statement (Please note: only certain companies are required to submit this. See above link.) Choose [Microsoft Word format] or [Adobe .pdf format]* 58-6-76
Fire & Casualty Publication Statement (Please note: only certain companies are required to submit this. See above link.) Choose [Microsoft Word format] or [Adobe .pdf format]* 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
Health Insurance Companies Risk Pool - Report of Covered Lives - Choose [Microsoft Word format] or [Adobe .pdf format]* 58-17-126
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 Refund Form 10-55A-6
Health Rate & Form Filing Requirements   
Property Casualty Rate & Form Filing Requirements   
Tax Credit for Principal or Regional
  Home Office		 Home Office Credit 58-5-93
Health Insurance Companies

Disproportionate Share Report - Choose [Microsoft Excel format] or [Adobe .pdf format]*
(See an example of a completed report.)

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*Opening and printing Adobe .pdf files requires Adobe Acrobat Reader. Click here as needed to download the free Adobe Acrobat Reader.

 


 

 

 

 


Division of Insurance
445 E. Capitol Avenue
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369

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