New Jersey Insurance License

Online

$120

Online

$150

Biennially

Online

$120

Online

$150

Biennially

Online

$70

Online

$50

Biennially

Online

$70

Online

$50

Biennially

TPA Registration Application 

Email Tim.Stroud@dobi.nj.gov or mail. 

$0

The completed Application Cover Sheet.

A copy of the applicant’s basic organizational documents, which shall include articles of incorporation, articles of association, partnership agreement, management agreement, trust agreement or other documents governing the operation of the applicant that are applicable to the applicant’s form of business organization.

A copy of the executed bylaws, rules and regulations, or other documents relating to the operation of the applicant’s internal affairs.

A list of the names, addresses and official positions of the persons responsible for the conduct of the affairs of the applicant, including, but not limited to if applicable:
a) the members of the board of directors, executive committee or other governing boardor committee;
b) the principal officers or partners;
c) shareholders owning or having the right to acquire 10% or more of the voting securities of the corporation or partnership interest of a partnership, or equity interest, in thecase of another from of business organization; and
d) any person or entity who has loaned funds to the applicant for the operation of the business.

A fully completed and notarized Biographical Affidavit for each of those persons identified in response above.

A statement of any criminal convictions and civil, regulatory or enforcement action, including actions related to professional licensing, taken or pending against any principal officer or owner of the applicant; and the relationship with any other business entity, including a parent corporation.

A copy of the applicant’s most recent financial statements audited by an independent certified
public accountant. If the financial affairs of the applicant’s parent company are audited by an independent certified public accountant, but those of the applicant are not, then a copy of the most
recent audited financial statement of the applicant’s parent company, audited by an independent certified public accountant, shall be sub-mitted. A consolidated financial statement of the applicant and the parent company shall satisfy this requirement unless the Commissioner determines that additional or more recent information is required for the proper administration of the Act. If providing a consolidated financial statement, include a consolidating income statement clearly showing the applicant’s activity. Please note that once approved, annual audited financial statements must be filed on a calendar year basis.

A copy of the applicant’s business plan.

Annual Third Party Administreator Financial Report 

Mail 

$100

Annually by June 1.