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Iowa Insurance Division

330 Maple St.
Des Moines, IA
50319-0065

Phone 515-281-5705
Fax 515-281-3059
Toll Free Consumer Line
877-955-1212
Agent Licensing
515-281-7757
Forms & Filing Instructions

  • Instructions and Application: New Applicants for Inividual Employer Workers' Compensation Self-Insurance in Iowa

  • Retaliatory Statement: Fees and related information pertaining to foreign company applications in Iowa

  • Violent Crime Control and Law Enforcement Act of 1994 (18. U.S.C. §§ 1033-1034)

  • Uniform Certificate of Authority Application (UCAA) - Iowa Uniform Certificate of Authority Application (UCAA) information
     
  • Premium Tax Return forms - Iowa premium tax return forms are available for downloading as PDF files
     
  • Custodial bank and/or security deposit affidavit forms to report monthly required deposit balances. Intended for use by Iowa life domestic insurers only. (Excel format)
     
  • Company Annual Statement/Form Filing Information for the following:
    • Life Insurers
    • Property & Casualty Insurers
    • Health (HMO & HMDI)
    • Fraternal Societies
    • County Mutual blank
    • State Mutual
    • Surplus Lines

     
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