Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

Filings and Forms

The following documents are provided in Adobe .pdf format* unless otherwise noted.

Company Type Form South
Dakota
Codified
Law
Life, Accident, Health Insurers Checklist for Filings in 2014 58-6
Property Casualty Checklist for Filings in 2014 58-6
Health Entities Checklist for Filings in 2014 58-6
Fraternal Companies Checklist for Filings in 2014 58-6
Title Companies Checklist for Filings in 2014 58-6
Unauthorized Insurers Writing
  Business in SD
Checklist for Filings  58-6
Holding Company Form A - Electronic Version 58-5A
Holding Company Form B - Electronic Version 58-5A
Holding Company Form C - Electronic Version 58-5A
Holding Company Form D - Electronic Version 58-5A
Holding Company Form E - Electronic Version 58-5A
Health Insurance Companies The market survey report is not currently being requested.

Life & Health

Publication Statement
(See list of companies required to complete the Publication Statement.) (in Adobe .pdf format*)

58-6-76

Fire & Casualty

 

Publication Statement
(See list of companies required to complete the Publication Statement.) (in Adobe .pdf format*)

58-6-76
Property Casualty, Life/Health,
  Title            
Statement of Deposit 58-7
Health Maintenance Organization Statement of Deposit 58-7
Risk Retention Group Registration Packet 58-6A
Risk Purchasing Group Registration Packet 58-6A
Accredited or Qualified Reinsurer Registration Packet 58-14
Health Insurance Companies Risk Pool Report of Covered Lives
(Microsoft Word .docx format**)
58-17-126
Company Appointments and
  Terminations 
Producer or Business Entity Multi Appointment Form  58-30
Company Appointments and
  Terminations 
Notice of Termination of Company Appointment  58-30
Insurance Companies Premium Tax Refund Form 10-55A-6
Health Rate & Form Filing Requirements
Property Casualty Rate & Form Filing Requirements 
Tax Credit for Principal or Regional
  Home Office
Home Office Credit 58-5-93
Health Insurance Companies

Disproportionate Share Report
(See an example of a completed report.)

20:06:55:28
Captive Insurance Companies Captive Insurance Company Application  

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Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369