Kansas Insurance Commissioner
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