Illinois third party administrator 2025

1. Click ‘Get Form’ to open the Illinois Third Party Administrator application in the editor.
2. Begin by entering the name of the TPA in the designated field, followed by the Tax or Social Security number.
3. Fill in the address of your Principal Administrative Office, including telephone number, city, state, and zip code.
4. Select your type of business organization (Corporation, Partnership, or Proprietorship) and provide relevant details such as year of incorporation or formation.
5. List individuals responsible for the TPA's conduct along with their titles and addresses. If more space is needed, attach a separate sheet.
6. Complete the bond requirement section by indicating estimated amounts for contributions and claims expenses. Check if claiming a bond exemption if applicable.
7. Answer all regulatory questions regarding previous licenses and affiliations accurately. Ensure all necessary attachments are included.
8. Finally, sign and date the application at the bottom to certify that all information provided is accurate.

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