• FIS 0174 
Accredited or Trusteed Reinsurer Certificate of Assuming Insurer (AR-1 Form)

• FIS 2214 Captive Insurer Application 
Includes supporting forms and instructions to make application for a Captive Insurer limited certificate of authority.

• Annual Reporting for Captive Insurance Companies

• FIS 0406 and FIS 0407 

• FIS 0409 

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

• Financial Statement Instruction Booklets and Forms
UPDATED 1/17/2012-Use this link for complete form and instruction packets.

• Life, Accident & Health Insurers/Fraternal Benefit Societies/United States Branches of Non-US Insurers

• Property and Casualty/Title Insurers/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 0260 
Report of Risk Retention Group Premium and Tax

• FIS 0233 
Application for Foreign Risk Retention Group Registration

• 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)

• Electronic Resident and Non-Resident Licensing applications

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

• FIS 0200 
Insurance Business Entity Affiliate Disclosure

• FIS 0201 
dba Registration

• 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 change - for all licensees. Address change - must be used by agencies and may be used by individual licensees.

• Address Change Request for all individual licensees
Any non-resident adjuster must have only one home state license or must use form FIS 0262 (below).

• 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 
Annual Notice of Medicaid Claims Defects

• FIS 0284 
Clean Claim Report

• 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 0810 
Application for Authority to Purchase Discretionary Group Life Insurance

• 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

• MEWA application filing package 
includes all forms and instructions except Exhibit 1

• MEWA Pro Forma Balance Sheet 
(Exhibit 1)

• 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 2260 - Application for Verifying Eligiblity as Surplus Lines Insurer 

• 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 0865 
TPA Jurat Page for Annual Renewal

• FIS 0860 
Consent to Service - Third Party Administrator

• Application Form

• Michigan-Specific Application Checklist and Forms

• Schedule of Company Fees, Taxes and Deposits