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Biographical Affidavits

All applications for an Ohio Certificate of Authority must contain biographical affidavits, including those from health insuring corporations. Form 11, ”Biographical Affidavit,” of the NAIC Uniform Certificate of Authority Application should be used for this purpose. Select “Forms” at www.naic.org/industry_ucaa.htm to download this form.

The Ohio Department of Insurance also requires verification of all biographical affidavits by independent third parties used for verification in Ohio. Note that the Ohio list differs from the NAIC list. Not all NAIC approved independent third parties indicated a willingness or ability to provide this service to Ohio. Verifications must be sent to the Ohio Department of Insurance at the address below directly by the independent third party.

Questions regarding all applications for certificate of authority should be addressed to Cam Piatt at cameron.piatt@insurance.ohio.gov or (614) 728-1074.

Send applications to:
Ohio Department of Insurance
Office of Risk Assessment
50 W. Town Street
Third Floor - Suite 300
Columbus, Ohio 43215
Attention: Cam Piatt

An application for certificate of authority may be submitted at any time throughout the year.

Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, Ohio  43215
Mike DeWine, Governor | Jillian Froment, Director
General Info: 614-644-2658 | Consumer Hotline: 800-686-1526
Fraud Hotline: 800-686-1527 | Medicare Hotline: 800-686-1578
ODI Services