North Carolina Department of Insurance

Please Note

We are a service company that can help you file with the North Carolina Department of Insurance. We are not associated with this nor any other government agency. We offer paid services and software to help you file. You are not required to purchase our service to file - you may file directly with this agency without using our service.

Contact Information

Physical address:
NC Dept. of Insurance Company Licensing and Registration
1203 Mail Service Center
Raleigh, NC 27603

Phone: (919) 807-6140
Fax: (919) 807-6638

Web: Home Name search

Licenses

We track the following licenses with the North Carolina Department of Insurance in order to provide compliance services to our clients. As a client, you see this and other reference data in License Manager in-line with your licenses.

A laptop placed on a desk with our License Manager software on display

North Carolina Auto Physical Damage License - Non-Resident

Agency:	North Carolina Department of Insurance
Foreign Qualification is Prerequisite:	Not Set
Exam Required?	Not Set
Registered Agent (Special Agency) Required?	Not Set

Agency:	North Carolina Department of Insurance
Law:	NC Stat. § 58-3-6
Foreign Qualification is Prerequisite:	Not Set
Organization Age Requirement:	3 years of continuous existence immediately preceeding licensure.
Minimum Unrestricted Cash or Cash Equivalent Requirement:	$100,000
Exam Required?	Not Set
Registered Agent (Special Agency) Required?	Not Set

Form:	Charitable Gift Annuities Notification Form
Agency Fee:	$0
Notes:	North Carolina charities must provide notice within 90 days of when they first enter into a charitable gift annuity agreement. Notices must identify the organization, certify that the organization is a charity and that the annuities issued are qualified charitable gift annuities, and be signed by an officer or director. Charities must also provide their most recent IRS form 990 upon request from the department.

Filing Method:	Online
Agency Fee:	$1,000 application fee + $48 processing fee.

Form:	PEO-18 - Professional Employer Organization Initial De Minimis Registration Notification
Filing Method:	Mail or email to SpecialEntitiesSubmissions@ncdoi.gov.
Agency Fee:	$1,000
Original Ink:	Not required
Required Attachments:	A list by jurisdiction of each name under which the applicant has operated in the preceding 5 years, including any alternative names, names of predecessors and, if known, successor business entities. Form PEO-02: Biographical Affidavit for each controlling person List of officers, directors and controlling persons Names of all persons or entities who directly or indirectly own, control, hold with the power to vote, or hold proxies representing 10% or more of the voting securities of the applicant. List of all client companies in North Carolina Form PEO-04: Power Of Attorney if the applicant is a nonresident For each client company listed in section 3, attach evidence of workers' compensation coverage for all assigned employees in North Carolina A copy of a license or registration evidencing that the registrant is either licensed or registered as a PEO in at least one other state Form PEO-17: Workers' Comp Attest

Form:	PEO-19 - Professional Employer Organization Annual De Minimis Registration Notification
Filing Method:	Mail or email to SpecialEntitiesSubmissions@ncdoi.gov.
Agency Fee:	$0
Due:	Annually by January 15.
Original Ink:	Not required
Required Attachments:	Form for nonresidents (PEO-04) Form PEO-19 (Annual Notification form)

Form:	Form PEO-01: Professional Employer Organization License Application
Filing Method:	Mail or email to SpecialEntitiesSubmissions@ncdoi.gov. Forms requiring notarization must be sent in the mail.
Agency Fee:	$1,000
Required Attachments:	A list by jurisdiction of each name under which the applicant has operated in the preceding 5 years, including any alternative names, names of predecessors and, if known, successor business entities. Form PEO-02: Biographical Affidavit for each controlling person List of officers, directors and controlling persons Names of all persons or entities who directly or indirectly own, control, hold with the power to vote, or hold proxies representing 10% or more of the voting securities of the applicant. A list of all offices located in North Carolina Description of the applicant's operations in the state of North Carolina List of all client companies in North Carolina Surety bond, letter of credit, or cash deposit Form PEO-04: Power Of Attorney if the applicant is a nonresident Form PEO-05: Obligations Attestation A copy of the applicant's most current audited GAAP financial statement, prepared as of a date not more than 90 days before the date of application A complete set of fingerprints for each officer, director, and controlling person If the applicant is organized under the laws of another state as a corporation, limited partnership, limited liability partnership, or limited liability company, attach a current copy of the relevant certificate or a copy of the current annual report issued by the North Carolina Secretary of State evidencing the applicant's authority to conduct business in North Carolina If the applicant is organized under North Carolina law as a corporation, limited partnership, limited liability partnership, or limited liability company, attach a current copy of the relevant certificate or a copy of the current annual report issued by the North Carolina Secretary of State For each client company listed in section 3, attach evidence of workers' compensation coverage for all assigned employees in North Carolina Form PEO-17: Workers' Comp Attest

Instructions:	Annual Filing Requirements
Agency Fee:	$1,000
Due:	Annually within 120 days after the close of the PEO's fiscal year.
Required Attachments:	Audited GAAP financial statement Form PEO-05: Obligations Attestation Form PEO-06: CEO and CFO Fin Stmt Attest Any changes to information reported on the initial registration application Current Surety Bond, Letter of Credit, or Current Statement of Securities Current client list of all North Carolina clients serviced by the PEO

Form:	Form PEO-05: Obligations Attestation
Agency Fee:	$0
Due:	Within 45 days after the end of each fiscal year quarter.
Notes:	Licensees must submit financial reports including GAAP financial statements and the obligation attestation form every quarter.

Form:	Form PEO-13: Notification of Change in WC Ins or HB Plan
Agency Fee:	$0
Due:	No later than 10 days after discontinuance.
Notarize:	Required
Notes:	PEOs must notify the client company and the Commissioner about a discontinuance and replacement, if any, of any health plan or workers' compensation insurance coverage.

Form:	Form PEO-10: Notification of Change
Agency Fee:	$50 if there is a change to the name of the licensee, otherwise there is no fee.
Due:	Within 30 days of a change.
Notes:	Licensees must report a change in name of licensee, change in location of licensee’s primary business office, addition of business office in NC, deletion of business office in NC, change in location of a business office in NC, addition of controlling person, deletion of controlling person, and any other material change in business structure, bankruptcy filing, any regulatory or judicial action against licensee.

Form:	Form PEO-11: Notification of Initiation of Client Company or Form PEO-12: Notification of Termination of Client Company
Agency Fee:	$0
Due:	Within 30 days of initiation or termination of a client company relationship.
Notes:	Licensees must file a notification when initiating or terminating a client company relationship.

Form:	TPA Registration Application
Filing Method:	Email LHinbox@ncdoi.gov
Agency Fee:	$300
Required Attachments:	Biographical affidavits of TPA officers and director, By-laws of TPA, Organizational documents of TPA, such as articles of incorporation, partnership agreement, etc., including all amendments, Narrative discussing internal controls of TPA operations, General description of business operations, Executed copy of the administrator's power of attorney, ONLY for non-domestic TPA. Forms available here.

Form:	TPA Registration Application (Renewal)
Filing Method:	Email LHinbox@ncdoi.gov
Agency Fee:	$300
Due:	Annually by date of issuance.
Required Attachments:	A list of the TPA officers and directors, a list of insurance companies with which the TPA has administrative agreements & certification that company will provide signed copy if requested, current evidence that the TPA employs a licensed agent, ONLY if the TPA solicits new or renewal insured business, current evidence of E&O or liability insurance, and copy of current domestic license - ONLY if TPA is a non-domestic company.

Compliance Software

Compliance Services

North Carolina Department of Insurance

Please Note

Contact Information

Licenses

North Carolina Auto Physical Damage License - Non-Resident

Initial Registration

Registration Renewal

North Carolina Auto Physical Damage License - Resident

Initial Registration

Registration Renewal

North Carolina Auto Rental Limited License - Non-Resident

Initial Registration

Registration Renewal

North Carolina Auto Rental Limited License License - Resident

Initial Registration

Registration Renewal

North Carolina Broker License - Non-Resident

Initial Registration

Registration Renewal

North Carolina Broker License - Resident

Initial Registration

Registration Renewal

North Carolina Charitable Gift Annuity Registration

Initial Registration

Renewal Not Required

North Carolina Collection Agency License

Initial Registration

Registration Renewal

Amendment

Amendment

North Carolina Comp / Independent Firm Adjuster License - Non-Resident (No Home State)

Initial Registration

North Carolina Company / Independent Firm Adjuster License - Non-Resident

Initial Registration

Registration Renewal

North Carolina Company/Independent Firm Adjuster License - Resident

Initial Registration

Registration Renewal

North Carolina Corporation License - Non-Resident

Initial Registration

Registration Renewal

North Carolina Corporation License - Resident

Initial Registration

Registration Renewal

North Carolina Country Farm Mutual Insurance Agent License - Resident

Initial Registration

North Carolina Credit Agent License - Non-Resident

Initial Registration

North Carolina Credit Agent License - Resident

Initial Registration

North Carolina Hail Adjuster License - Non-Resident

Initial Registration

Registration Renewal

North Carolina Hail Adjuster License - Resident

Initial Registration

Registration Renewal

North Carolina Individual Insurance Producer License

Initial Registration

Renewal Not Required

North Carolina Insurance Agency License

Initial Registration

Registration Renewal

North Carolina Insurance Agent License

Initial Registration

North Carolina Insurance Business Entity License - Corporation

Initial Registration

Registration Renewal

North Carolina Insurance Producer License - Non-Resident

Initial Registration

Renewal Not Required

North Carolina Insurance Producer License - Resident

Initial Registration

North Carolina Limited Lines Travel Business Entity License - Resident

Initial Registration

Registration Renewal

North Carolina Limited Lines Travel Business License - Non-Resident

Initial Registration

Registration Renewal

Financial Reporting
Quarterly Report

Amendment
Notification of Change in Workers’ Compensation Insurance or Health Benefit Plan

Amendment
Notification of Change

Amendment
Notification of Initiation or Termination

Financial Reporting
Quarterly Report

Amendment
Notification of Change in Workers’ Compensation Insurance or Health Benefit Plan

Amendment
Notification of Change

Amendment
Notification of Initiation or Termination