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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 Manufacturer Reporting

OIR-A3-1984 Motor Vehicle Manufacturer Annual Report

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)