Department of
Insurance

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Surplus Lines Insurer
Filing Requirements for Status Changes

The following documents are required:

Name Change:

1. A certified copy of Certificate of Compliance reflecting the new company name issued by the state of domicile.
2. Complete UCAA Form 2c.

Redomestication:

1. A certified copy of Certificate of Compliance issued by the new state of domicile.
2. Complete UCAA Form 2c

For all other status changes, please submit a written notification with a brief explanation.

Please submit the above documents to:

Jean Chang
Examinations Section
Idaho Department of Insurance
700 West State Street, 3rd Floor
P.O. Box 83720
Boise, ID 83720-0043
(208) 334-4311