• Forms for Filing Financial Statements

    The forms listed below are financial filing statements for: Life, Accident and Health Insurers/Fraternal Benefit Societies/United States Branches of Non-US Insurers

    For questions about the annual statements, quarterly statements, and Michigan supplemental forms, contact DIFS at 517-284-8749 or toll free at 877-999-6442.

Forms for Filing Financial Statements

  • FIS 0063 PDF icon

    Valuation of Section 411 Trusteed Assets Under Section 901 - Life and A&H

  • FIS 0079 PDF icon

    Fraternal Benefit Society Qualifying Assets Under Section 901

  • FIS 0081 PDF icon

    Life, Accident and Health Insurers Qualifying Assets Under Section 901

  • FIS 0082 PDF icon

    Non-Insurance Entity Qualifying Assets Under Section 901(1)

  • FIS 0318 PDF icon

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

  • FIS 0322 PDF icon

    Michigan Health Insurance Enrollment, Premiums and Losses
    NOTE:  DIFS no longer accepts paper copies of FIS 0322.  Companies must submit via DIFS Online Services portal.