Alabama Department of Insurance

Domestic Insurers are required to file the following documents by applicable dates:

• Annual Financial Statement - March 1
• Annual Audit and Examination Fee - March 1
• Annual Fraud Unit Assessment Fee - June 1
• 3 Quarterly Financial Statements - May 15, August 15, and November 15
• Management Discussion and Analysis - April 1
• Audited Financial Statements (CPA Report) - June 1
• Form A – click HERE to electronically submit PDF copy of Form A and payment of $2,500 fee.
• Form A Amendment – click HERE to electronically submit PDF copy of Amendment to Form A and payment of $1,250 fee.
• Form A Exemption – click HERE to electronically submit PDF copy of an Application for Exemption from Form A and payment of $1,250 fee.
• Disclaimer of Affiliation – click HERE to electronically submit PDF copy of a Disclaimer of Affiliation and payment of $1,250 fee.
• Form B (including a $650 fee) - June 1
• Form B Exemption (including a $200 fee) - June 1
• Form C (including a $650 fee) - June 1
• Form D (including a $650 fee)
• Form E (including a $250 fee)
• Form E Exemption (including a $100 fee)
• Form F (including a $250 fee)
• Solicitation Permit – click HERE to electronically submit PDF copy of Application for Soliciation Permit and payment of $250 fee.

• Captive Insurer Tax Form
• Domestic Insurance Companies
• Foreign Insurance Companies
• Independently Procured Insurance
• Non-Profit Hospitalization
• Purchasing Groups
• Surplus Line Brokers
• Risk Retention Companies

• Procedures and Forms

All Sections listed on the following pages have instructions. Please download these instructions along with the required form.

• As standard printed forms, these would be "front and back".
• As PDF Downloads - please make sure you print all of the pages of the form.

• Long-Term Care Medicaid Certification

• Form AR-1
• Form CR-1
• Form CR-F Pt. 1
• Form CR-F Pt. 2
• Form CR-S Pt. 1 Sec. 1
• Form CR-S Pt. 1 Sec. 2
• Form CR-S Pt. 2
• Form CR-S Pt. 3 Sec. 1
• Form CR-S Pt. 3 Sec. 2
• Certified Reinsurers List

• Application for Registration as a Risk Retention Group
  (Requires Microsoft Word)
• Agent for Service of Process Change Form
  (Requires Adobe Acrobat Reader)
• Refund Claim Form
  (Requires Adobe Acrobat Reader)
• Alabama Group Mental Health Parity Cost Report
  (Requires Adobe Acrobat Reader)
• Small Group Market Data and Experience Report
  (Requires Microsoft Excel)
• Vehicle Protection Product Warrantors - License Application Form
  (Requires Adobe Acrobat Reader)
• Vehicle Protection Product Warrantors - Biographical Affidavit
  (Requires Adobe Acrobat Reader)
• Alabama Vehicle Protection Product Act
  (Requires Adobe Acrobat Reader)