• 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 0406 AND FIS 0407 
Application and Fee Card for CE Course/Provider Approval. Print and fill-in on paper form, compatible with Acrobat Reader version 5 and above.

• FIS 0409 
Application for Prelicensing Education Provider/Course Approval

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

• To apply for a limited certificate of authority for a captive insurance company under Chapter 46 or 47 of the Michigan Insurance Code, please contact Dave Piner in Supervisory Affairs Division, at 517-373-2391 or toll free at 1-877-999-6442.

• Financial Statement Instruction Booklets and Forms
UPDATED FOR 2007-Click here 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 0233 
Application for Foreign Risk Retention Group Registration

• FIS 0260 
Report of Risk Retention Group Premium and Tax

• 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)

• FIS 0325 
HMO/AFDS Submission of Certificate of Coverage, Rider, Rates

• Uniform Application for Non-Resident
Individual Insurance Producer License

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

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

• FIS 0200 
Agency Affiliation

• FIS 0201 
dba Registration

• FIS 0202 
Michigan Application for Resident Business Entity (Agency) Insurance License

• FIS 0220 
Michigan Application for Resident Individual Producer Insurance License.

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

• FIS 0223 
Fee Processing Card

• FIS 0225 Online Application for Individual Producer
Instructions for online PDF application form FIS 0225.

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

• FIS 0261
Insurance License Document Request

• FIS 0262 
Name and Address Change Form (now combined, replaces FIS 0263)

• 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 
Quarterly Notice of Medicaid Claims Defects

• FIS 0284 
Clean Claim Report

• FIS 0308 
Report of Multiple Medicare Supplement Coverage in Force for Michigan Residents

• 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 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

• NAIC Uniform Transmittal Documents

• Property and Casualty Filing Requirements 

• Life and Health Filing Requirements 

• 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-0860 
Consent to Service - Third Party Administrator

• Application Form

• Michigan Specific Application Checklist and Forms

• Schedule of Company Fees, Taxes and Deposits