Forms and Applications

This page provides links to many of the forms used by the Delaware Department of Insurance.

Arbitration Forms
Company Regulation Forms
Consumer Forms
Continuing Education Provider Forms
Fraud Forms
Freedom of Information Act (FOIA) Policy & Request Form
Home Inventory Form
Life and Health Filing Forms
Medicare Supplement Annual Filing Forms
Miscellaneous
Proof of Insurance (Regulation 606) Forms
Property and Casualty Filing Forms
Producer Licensing Forms
Surplus Lines Brokers Tax Filing Forms
Tax and Annual Renewal Forms (all companies including AR, SL, PG, and RRG)

Arbitration Forms

Go to Arbitration page.

How to File for Health Arbitration
Form to petition for health insurance arbitration
Form to respond to petition for health insurance arbitration
"Proof service" form required for health insurance arbitration

How to File for Auto Arbitration
Form to request auto insurance arbitration
Form to respond to auto insurance arbitration request
"Proof of service" form for auto insurance arbitration

How to File for Homeowner Arbitration
Form to request homeowner insurance arbitration
Form to respond to homeowner insurance arbitration request
"Proof of service" form for home insurance arbitration

Form to petition for health care reimbursement arbitration
Form to respond to petition for health care reimbursement arbitration
"Proof of Service" of Papers Required for Health Care Reimbursement Arbitration

Company Regulation Forms

For a more comprehensive list of BERG forms, go to the Company Regulations web page.

General Procedures and Information for Company Changes

Report of Delaware Medical Negligence Claims (18 Del. C. ' 6820)

UCAA - Certificate of Authority Applications/Information

UCAA - Corporate Amendments Application

Consumer Forms

Online complaint form

Complaint form (PDF format)

Authorization to release information (HIPAA privacy consent form)

Continuing Education Provider Forms

NAIC Uniform Continuing Education Reciprocity Course Filing Form

CE-4 Form - Continuing Education Course Report Form

Fraud Forms

These forms are for insurance company use only.

Uniform Suspected Insurance Fraud Reporting Form

Instructions for the Fraud Reporting Form

Note: The form is in Microsoft Word format. You may enter your information, print a hard copy, and mail it to Fraud Prevention Bureau, 841 Silver Lake Blvd., Dover, DE 19904. Or, complete the form, save it on your computer and then e-mail it to fraud@state.de.us.

Life and Health Filing Forms

Effective November 1, 2007, all filings must be submitted through SERFF. Hardcopy filings will no longer be accepted.

General Instructions

Small Employer Carrier Annual Information Filing Form
Click here to read the Memorandum from the Director

Medicare Supplement Annual Filing Forms

Form for Reporting Medicare Supplement Policies

Medicare Supplement Refund Calculation Form

Reporting Form for the Calculation of Benchmark Ratio Since Inception for Individual Policies

Reporting Form for the Calculation of Benchmark Ratio Since Inception for Group Policies

Reporting Form for Annual Medigap Rates

Miscellaneous Forms

State of Delaware Employment Application

Proof of Insurance (Regulation 606) Forms

Attachments/Forms For Compliance With Regulation 606

Delaware Insurance Certification Form

Notice Of Cancellation Or Termination Of Policy

Property and Casualty Filing Forms

Effective November 1, 2007, all filings must be submitted through SERFF. Hardcopy filings will no longer be accepted.

General Instructions

State Specific Requirements

Certification of Readability

Form A (from Regulation 603)

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