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Wi oci 029 authority form

Wi oci 029 authority form 2025

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The document is an application for a Certificate of Incorporation and Certificate of Authority for profit plans in Wisconsin, specifically for entities wishing to operate as insurance providers under Chapter 611 of Wisconsin Statutes. It includes sections for the applicant's information, authorization for inquiries by the Commissioner of Insurance, and biographical forms for key executives, detailing their qualifications and backgrounds necessary for licensing.

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Click ‘Get Form’ to open the wi oci 029 authority form in the editor.
Begin by entering the 'Name of Plan' at the top of the form, followed by the 'Street Address and/or P.O. Box', 'City', 'State', and 'Zip + 4'. Ensure all information is accurate for processing.
In the section regarding the type of insurer, select one from options such as 'Traditional Service Insurance Corporation' or 'Health Maintenance Organization'. This selection is crucial for your application.
Next, provide signatures from both the First and Second Executive Officers along with their respective dates. This confirms that all information provided is true and complete.
Complete the authorization section by filling in details about the applicant, including names and signatures of both President and Secretary, ensuring all fields are filled correctly.
Finally, review all entries for accuracy before submitting. Use our platform's features to save your progress or make edits as needed.

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