NEVADA DIVISION OF INSURANCE STATE SPECIFIC REQUIREMENTS REDOMESTICATION Company Name: The following requirements are to be submitted on the UCAA Uniform Certificate of Authority Amendment application found at . Form 1C and 2C must be completed. A short statement of the information to be changed and the effective date of change The company's current original Nevada Certificate of Authority or an Affidavit of Loss signed by the President of the company Certified copy of the license and/or a Certificate of Compliance issued by the company's new state of domicile Certified copy of the Articles of Incorporation, if amended Certified copy of the By-laws, if amended Certified copy of the redomestication agreement signed by the regulatory agencies involved if applicable List of any new officers or directors (Biographical Affidavits for domestics) Amended Uniform Consent to Service of Process (UCAA Form 12) Completed Change of Address Form Application Filing Fees as below, or retaliatory if greater Please refer any questions to (775) 687-0753 Submit the above information via UCAA electronic means (preferred), CD or flash drive to: Nevada Division of Insurance Corporate & Financial Affairs 1818 E. College Parkway, Suite 103 Carson City, NV 89706 Send payment to the Nevada Division of Insurance via ACH or Check. ACH - MUST submit at time of payment Check - Submit remittance advice with your check if paying an invoice; otherwise note “Application Fees” on the check Applicant Redomesticated From NV ID Applicant Redomesticated To NAIC Effective Date Fees Fees Received Fees Fee Description Needed $10 Amend Certificate of Authority Date Rec’d $10 Amended Articles of Incorporation Date Rec’d Date Rec’d $10 Amended Bylaws $10 Amended Service of Process Date Rec’d Total $ Rec’d Total $ Needed Invoice # for fees Invoice Date
NEVADA DIVISION OF INSURANCE STATE SPECIFIC REQUIREMENTS REDOMESTICATION Company Name: The following requirements are to be submitted on the UCAA Uniform Certificate of Authority Amendment application found at . Form 1C and 2C must be completed. A short statement of the information to be changed and the effective date of change The company's current original Nevada Certificate of Authority or an Affidavit of Loss signed by the President of the company Certified copy of the license and/or a Certificate of Compliance issued by the company's new state of domicile Certified copy of the Articles of Incorporation, if amended Certified copy of the By-laws, if amended Certified copy of the redomestication agreement signed by the regulatory agencies involved if applicable List of any new officers or directors (Biographical Affidavits for domestics) Amended Uniform Consent to Service of Process (UCAA Form 12) Completed Change of Address Form Application Filing Fees as below, or retaliatory if greater Please refer any questions to (775) 687-0753 Submit the above information via UCAA electronic means (preferred), CD or flash drive to: Nevada Division of Insurance Corporate & Financial Affairs 1818 E. College Parkway, Suite 103 Carson City, NV 89706 Send payment to the Nevada Division of Insurance via ACH or Check. ACH - MUST submit at time of payment Check - Submit remittance advice with your check if paying an invoice; otherwise note “Application Fees” on the check Applicant Redomesticated From NV ID Applicant Redomesticated To NAIC Effective Date Fees Received Fees Needed Fees Fee Description Date Rec’d $10 Amend Certificate of Authority Date Rec’d $10 Amended Articles of Incorporation Date Rec’d $10 Amended Bylaws Date Rec’d $10 Amended Service of Process Total $ Rec’d Total $ Needed Invoice # for fees Invoice Date
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