To become relisted or initially listed as an eligible nonadmitted insurer in the State of Kansas, please complete and submit this application. This application is due by May 1 annually to remain on the Kansas list of eligible nonadmitted insurers.
Name of Company:
Company NAIC:
By checking this box, I attest that the above-listed company has a capital surplus at or in excess of 15 million dollars on this year’s company annual statement.
Initial Applicants Only. A copy of your annual statement must be emailed to kdoi.rf@ks.gov Name of person completing application: Phone:
Email:
