Uniform Certificate of Authority Application

Kansas State Specific Forms

Please do not complete any of the forms listed below at the time of application. If your "Uniform Certificate of Authority Application" for a Kansas Certificate of Authority is approved, you will be contacted and requested to complete some of these forms depending upon the lines of business your company has applied to underwrite in Kansas.

For additional information contact Mark Owens by phone at 785-296-5350, or email at mowens@ksinsurance.org.

All documents are in PDF format unless otherwise indicated.

LINE OF BUSINESS FORMS TO BE COMPLETED
   
Fire Form3.pdf, Form18.pdf, Form19.pdf
Windstorm & Hail Form18.pdf
Extended Coverage Form18.pdf
Add'l Perils on Growing Crops Form18.pdf
Hail on Growing Crops Form18.pdf
Optional Perils Form18.pdf
Sprinkler Leakage Form18.pdf
Business Interruption Form18.pdf
Earthquake Form18.pdf
Water Damage Form18.pdf
Aircraft Hull Form18.pdf
Ocean Marine Form18.pdf
Inland Marine Form18.pdf
Rain None
Auto Physical Damage Form23.pdf, Form3.pdf, Form22.pdf*,
Form21.pdf*, Form7.pdf
Flood Form18.pdf
Homeowners Policies Form3.pdf
Farmowners Policies Form3.pdf
Automobile Liability Form23.pdf, Form3.pdf, Form22.pdf*,
Form20.pdf*, Form21.pdf*, Form7.pdf,
Form6.pdf
General Liability Form23.pdf, Form5.pdf, Form6.pdf
Workers' Compensation Form23.pdf, Form5.pdf, Form6.pdf
Fidelity, Surety & Forgery Bonds Form23.pdf
Glass Form18.pdf
Burglary, Theft & Robbery Form23.pdf, Form3.pdf
Boiler & Machinery Form23.pdf, Form3.pdf
Credit Form23.pdf
Title None
Malpractice Liability Form23.pdf, Form5.pdf, Form6.pdf
Livestock Mortality Form23.pdf, Form3.pdf
Aircraft Liability Form23.pdf
Cargo Liability Form23.pdf, Form18.pdf

* you must complete two (2) copies of this form