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  
  UCAA Corporate Amendments Application Information webpage  
All Insurance Companies Market Conduct Annual Statement (MCAS) Bulletin 16-04
Insurance Innovation Waivers Application and Information 58-48
Life, Accident, and Health Insurers and Fraternal Insurers Checklist for Filings in 2024 58-6
Property Casualty Checklist for Filings in 2024 58-6
Health Entities Checklist for Filings in 2024 58-6
Title Companies Checklist for Filings in 2024 58-6
Holding Company Form A 58-5A
Holding Company Form B 58-5A
Holding Company Form C 58-5A
Holding Company Form D 58-5A
Holding Company Form E 58-5A
Holding Company Form F 58-5A
Licensed Insurance Companies with Active Status Health Line of Authority 2024 Covered Lives-Market Survey Report Form (Adobe Sign format - complete and submit online)
Due date: May 15, 2024
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
Nonprofit Agricultural Organization Health Benefit Plan (Self-funded)

Health Benefit Plan Certification Form

Annual Filing Requirement

58-1-3.4
Multiple Employer Trust (MET) MET Application for Authorization

58-18

&

20:06:57

Reinsurer:

Accredited, Qualified, Certified, or Reciprocal Jurisdiction

Reinsurer Application and Filing Information

 

58-14


Risk Retention Group

Registration Packet

Annual Filing Checklist

Business Written and Premium Tax Report

Risk Retention Group Information (webpage)

58-6A
Risk Purchasing Group Registration Packet 58-6A
Surplus Lines

Surplus Lines Information (webpage)

 
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 10-44-2 and 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