• FIS 0849 Application Checklist. Please use to ensure all required application materials are submitted.
• FIS 0861 Application for Certificate of Authority.
• FIS 0860 Consent to Service. For entities domiciled in states other than Michigan.
• FIS 0862 Affiliation Statement. For all officers, directors, and stockholders of 10% or more stock.
• FIS 0863 Fee Processing Card.
• FIS 0850 Financial Statement.

Financial Viability

In lieu of submitting the FIS 0850 Financial Statement, an audited financial statement for the period ending closest to the date of application may be submitted, accompanied by the notarized first page of the FIS 0850. Audited financial statements of an applicant’s parent company are not relevant and will not be accepted.

A TPA will be considered financially viable under 550.912(1)(e) if (1) if it received an unqualified opinion from an independent public accountant showing it is solvent based upon generally accepted accounting principles, or (2) it remains solvent after adjusting for goodwill and intangible assets if no independent public accountant opinion is obtained. In the event an applicant or licensed TPA does not meet either of these criteria, they must submit other legitimate proof of financial viability to OFIS.