• FIS 0174 
Accredited or Trusteed Reinsurer Certificate of Assuming Insurer (AR-1 Form)

• FIS 0406 AND FIS 0407 
If you save this form to your computer, you can use Acrobat Reader's typewriter feature to complete the form, and save your changes. Requires the free Acrobat Reader v7.0.9 or higher.

• FIS 0409 
Application for Prelicensing Education Provider/Course Approval

• NAIC Uniform Continuing Education Reciprocity Course Filing Form (CER)

• FIS 2214 Captive Insurer Application 
Includes supporting forms and instructions to make application for a Captive Insurer limited certificate of authority.

• Annual Reporting for Captive Insurance Companies

• Financial Statement Instruction Booklets and Forms
UPDATED 1/15/2010-Use this link for complete form and instruction packets.

• Property and Casualty/Title Insurers/United States Branches of Non-US Insurers

• Life, Accident & Health Insurers/Fraternal Benefit Societies/United States Branches of Non-US Insurers

• Health Maintenance Organizations/Alternative Financing and Delivery Systems/Nonprofit Health Care Corporations/Dental Service Corporations

• Checklists of Financial Form Filings

• Instructions 
For Application for Registration

• FIS 0260 
Report of Risk Retention Group Premium and Tax

• FIS 0233 
Application for Foreign Risk Retention Group Registration

• FIS 0234 
Consent to Service - Foreign Risk Retention Group

• FIS 0235 
Foreign Risk Retention Group Registration Fee Card

• FIS 0361 
Affiliate Statement

• FIS 0364 
Report of Operations

• HMO/AFDS Application Instructions, Exhibits and Attachments 

• FIS 0273 
HMO/AFDS Application for Certificate of Authority

• FIS 0274 
Appointment for Authorized Representative

• FIS 0276 
HMO Summary of Contracted Health Professionals

• FIS 0277 
AFDS Summary of Contracted Health Professionals

• FIS 0281 
HMO/AFDS Profile of Contracted Health Professionals

• FIS 0282 
Summary of Ancillary Providers

• FIS 0283 
Summary of Contracted Hospitals

• FIS 0284 
Model Trust Indenture

• FIS 0285 
Deposit Instructions (HMO)

• Electronic Resident Licensing and Non-Resident Licensing applications

• Uniform Application for Resident and Non-Resident Business Entity (Agency) Insurance License

• Application for Written Consent to Engage in the Business of Insurance 
Pursuant to 18 USC Section 1033 and 1034

• FIS 0200 
Insurance Business Entity Affiliate Disclosure

• FIS 0201 
dba Registration

• FIS 0221 
Michigan Application for Individual Non-Producer Insurance License

• FIS 0223 
Fee Processing Card

• FIS 0242 
Appointment/Cancellation of Managing General AGENT or AGENCY (combines and replaces form FIS 0243)

• FIS 0261
Insurance License Document Request

• Address Change Request for all individual licensees. Any non-resident adjuster must have only one home state license, or must use form FIS 0262 (above)

• FIS 0262 
Name change - for all licensees. Address change - must be used by agencies and may be used by individual licensees.

• FIS 0066 
Amendment or Restatement of Michigan Articles of Incorporation Form and Checklist

• FIS 0144 
Request for Determination of Exemption from Requalification Form

• FIS 0169 
Articles of Incorporation

• FIS 0170 
Michigan Auto Certification

• FIS 0278 
Medicaid Clean Claim Report

• FIS 0279 
Annual Notice of Medicaid Claims Defects

• FIS 0284 
Clean Claim Report

• FIS 0318 
Complaint and Grievance Summary for Health Carriers. FIS 319 was merged into FIS 0318.

• FIS 0376 
Fire Insurance Withholding Program - Enrollment Requirements

• FIS 0378 
Auto Insurance Fire Loss - Enrollment Requirements

• FIS 0425 
Oath of Director of a Michigan Domestic Insurer

• FIS 0810 
Application for Authority to Purchase Discretionary Group Life Insurance

• FIS 0983 
Long-Term Care Insurance Annual Sales Report

• Instructions

• Form A 
Statement Regarding the Acquisition of Control of or Merger with a Domestic Insurer

• Form B 
Insurance Holding Company System Annual Registration Statement

• Form C 
Summary of Registration Statement

• Form D 
Prior Notice of a Transaction

• MEWA application filing package 
includes all forms and instructions except Exhibit 1

• MEWA Pro Forma Balance Sheet 
(Exhibit 1)

• Instructions 
For Application for Licensure

• FIS 0853 
Premium Finance Company License Fee Card

• FIS 0855 
Premium Finance Company Balance Sheet

• FIS 0856 
Application For Insurance Premium Finance Company License

• FIS 0857 
Statement of Owners, Officers, and Directors of a Premium Finance Company

• FIS 0858 
Insurance Premium Finance Company Corporate Surety Bond

• Public Employer Pool Plan (Pool) application filing package 
Includes all forms and instructions except Exhibit 1

• Pool Pro Forma Balance Sheet 
(Exhibit 1)

• FIS 0359 
Purchasing Group Application for Registration

• FIS 0255 
Report of Insurance Purchased From an Unauthorized Insurer

• FIS 0362 
Annual Renewal Report for Purchasing Groups

• FIS 0363 
Change in Registration for Purchasing Groups

• FIS 0364 
Report of Operations

• FIS 0365 
Consent to Service - Purchsing Groups

• FIS 0845 
Reinsurance Intermediary Manager Michigan License Application

• FIS 0846 
Consent to Service - Non-Resident Reinsurance Intermediary Manager

• FIS 0255 
Report of Insurance Purchased From an Unauthorized Insurer

• FIS 0269 
Report of Transaction with an Unauthorized Insurer Not Recognized as Eligible

• FIS 0270 
Surplus Lines Agent Semi-Annual Report of Michigan Premiums and Tax

• FIS 0849 
Application Checklist for Third Party Administrators

• FIS 0861 
Third Party Administrator Application for Certificate of Authority

• FIS 0862 
Third Party Administrator Affiliation Statement

• FIS 0863 
TPA Fee Processing Card

• FIS 0850 
Financial Statement for Third Party Administrators

• FIS 0865 
TPA Jurat Page for Annual Renewal

• FIS 0860 
Consent to Service - Third Party Administrator

• Application Form

• Michigan-Specific Application Checklist and Forms

• Schedule of Company Fees, Taxes and Deposits