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Specialty Product Administration

Annual Statement Forms

The Forms provided here are for informational purposes only. All licensed companies must file electronically via the Industry Portal and the Regulatory Electronic Filing System (REFS).  A User Guide and a Tutorial for filing electronically is available and can be accessed at /OIR_Required_Filing_Reporting.htm, with additional information provided in the Informational Memorandum shown on the same webpage. Licensed companies must report electronically via the Industry Portal.

* Forms marked with an Asterisk (*) should be printed, completed and mailed to the address provided thereon. When filing in REFS, companies should scan and upload a copy of the completed Form with their electronic filing.

Continuing Care Reporting

OIR-A3-470 

Continuing Care - Annual Report

OIR-A3-477

Continuing Care Minimum Liquid Reserve Calculation

Donor Annuity Reporting

OIR-A3-1209

Sworn Statement in Lieu of Annual Statements for Issuers of Donor Annuity Agreements

Home Warranty Reporting

OIR-A3-440

Home Warranty Annual Tax (*)

OIR-A3-491

Home Warranty Annual Report

OIR-A3-1073

Home Warranty Renewal (*)

Legal Expense Insurance Reporting

OIR-A3-479 

Legal Expense Insurance Annual Report

OIR-A3-1077

Legal Expense Insurance Renewal (*)

Motor Vehicle Service Agreement Reporting

OIR-A3-467

Motor Vehicle Service Agreement Annual Report

OIR-A3-467LR

Motor Vehicle Service Agreement Renewal

Premium Finance Reporting

OIR-A3-107

Premium Finance Annual Report

OIR-A3-1563

Premium Finance Renewal (*)

Service Warranty Reporting

OIR-A3-456

Service Warranty Annual Report

OIR-A3-110

Service Warranty Renewal (*)

OIR-A3-458

Service Warranty (Publicly Traded) Annual Report

OIR-A3-955

Service Warranty Manufacturer Renewal (*)

Insurance Administrator Reporting

OIR-A3-975

Insurance Administrator Annual Report

Viatical Settlement Provider Reporting

OIR-A3-1288

Viatical Settlement Provider Annual Report (form is currently subject to litigation)