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Below you will find a listing of every state-specific form that applies to life, accident and health companies under the Financial Reporting and Tax Requirements section of the North Dakota Insurance Department website. Please refer to the general information under the Filing Requirements for Licensed Companies section.

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Renewal Statement For Admitted Companies

The Renewal Statement for Admitted Companies must be submitted using OPTins.

Forms

Life Company Abstract of Statement (SFN 4802)

  • Electronic filing of the company's abstract form is required.
  • March 1 is the deadline for submitting the electronic abstract form.
  • A filing fee of $30 is imposed by N.D.C.C. § 26.1-01-07.
  • Publication fees are imposed under N.D.C.C. § 26.1-03-10 and N.D.C.C. § 46-05-03 and are billed directly to the insurance company by the North Dakota Newspaper Association.
  • If amended abstract forms are filed after the March 1 deadline, an additional $30 filing fee and any applicable re-publication fees will be payable.

Life, Accident and Health/Fraternal Insurers Checklist

Insurance Data Security Certification (SFN 62101)