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Uniform Certificate of Authority Primary Application
Louisiana State Specific Items

Prior to submission of an application for a Certificate of Authority, a Louisiana domiciled insurer must be incorporated and funded. For information on the incorporation process of a Louisiana domiciled insurer and the filing process for the initial Articles of Incorporation, click here.

In addition to all other requirements of the Uniform Certificate of Authority (UCAA) Primary Application, an applicant must also submit the following in association with an application for a Certificate of Authority in Louisiana.

  • A copy of the acceptance of trust executed by each director of the company. You may find a sample form of the Directors Acceptance of Trust by clicking here but the domestic insurer is free to develop its own form.


  • A copy of the oath of officer executed by each officer of the company. You may find a sample form of the Oath of Officer by clicking here but the domestic insurer is free to develop its own form.


  • A completed Agreement to Comply with Rates, Rules and Regulations form.


  • A copy of an agreement between the applicant and an independent qualified auditor agreeing to engage the auditor for at least three consecutive years for the purpose of providing an annual audited financial statement for the insurer to the Commissioner. The agreement must be signed by the president of the insurer.


  • A copy of an agreement between the applicant and an independent qualified actuary agreeing to engage the auditor for at least three consecutive years for the purpose of providing an annual actuarial reserve analysis for the insurer to the Commissioner. The agreement must be signed by the president of the insurer.


  • The application form (Form 2P) must be executed by all of the directors of the corporation rather than the officers.


  • A safekeeping or trust receipt from a bank doing business within the state or from a savings and loan association chartered to do business in this state verifying that the applicant has deposited one hundred thousand dollars ($100,000.00) in money or acceptable bonds (Acceptable bonds are defined as bonds issued by the United States Government or the State of Louisiana or any political subdivision of the State of Louisiana.) with that institution and pledged said deposit to the Commissioner of Insurance. The banks have the necessary pledge forms. Do not contact this Office to request one.


  • Third party verification reports for all persons for whom biographical affidavits are supplied. The reports must be prepared by one of the firms included on the list made available by the National Association of Insurance Commissioner for the Uniform Certificate of Authority Application. You may view a copy of this list by clicking here. The applicant should advise the investigator that the reports are being prepared for the Louisiana Department of Insurance and make the necessary arrangements for payment. See the information below regarding waiver of this requirement.


  • A detailed description of the corporate organizational/ownership structure of the applicant, its parent company and all affiliates. This description should include a chart showing the ownership percentages for any persons owning 10 percent or more of the applicant and all affiliated entities up to and including the ultimate controlling person. The chart must include the state of domicile and the Federal Employer Identification Number (FEIN) for each person. For a sample chart please go to our website at http://www.ldi.state.la.us/Licensing/Company/index.html. The Attestation of Ownership must be attached to this exhibit. If there is no person who owns, directly or indirectly, 10 percent or more of the applicant then you must provide a statement to that effect in lieu of this exhibit.


  • Fees in the amount of $2,500.00. All checks should be made payable to the Louisiana Department of Insurance and the LDI may convert your payments by check to an electronic Automated Clearinghouse (ACH) debit transaction. This means that your account may be debited the day your check is received by the LDI. Although the debit transaction will appear on your bank statement, your check will not be returned to your bank. If the electronic fund transfer cannot be processed for technical reasons, you authorize us to process the copy of your check.

ELECTRONIC SUBMISSION OF APPLICATION

If the application is submitted electronically using the National Association of Insurance Commissioner Uniform Certificate of Authority electronic submission process or via email to companyapps@ldi.state.la.us, the only “hard copy” filing requirements for the application would be for payment of the application fee. There is no need to submit any other portion of the application hard copy if a complete application is filed electronically. However, on all imaged documents that require notarization or certification , the notarization or certification seal must be clearly visible on the image.