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Annual Statement Filing Checklists & Instructions    
All Annual Statement filings submitted to the Kentucky Department of Insurance shall be completed in accordance with the National Association of Insurance Commissioners' Accounting Practices and Procedures Manual, as amended, pursuant to KRS 304.3-240. All filings MUST BE POSTMARKED no later than the indicated due date even if that due date falls on a weekend or holiday.

The forms and documents are grouped via categories (click the category for specific documents):
Fraternal Societies (Foreign and Domestic)   Health Entities (Foreign)   Health Entities (Domestic)  
Life, Accident and Health (Foreign)   Life, Accident and Health (Domestic)   Property & Casualty (Domestic)  
Property & Casualty (Foreign)   Title (Foreign)   Assessment Fire  
Risk Retention Groups, Accredited Reinsurers   Other Approved Reinsurers, Surplus Lines  
 
Fraternal Societies (Foreign and Domestic) Back to top
Annual Statement and Other Instructions [PDF-435K]
Form 385 - Application for Fraternal Societies  [PDF-28K]
Form 440 - Certificate on Advertising  [PDF-65K]
NAIC Checklist for Fraternals [PDF-947K]
 
Health Entities (Foreign) Back to top
Annual Statement and Other Instructions [PDF-435K]
Form 440 - Certificate on Advertising [PDF-67K]
Form 440 - Certificate on Advertising  [PDF-65K]
NAIC Checklist for Health [PDF-904K]
 
Health Entities (Domestic) Back to top
Annual Statement and Other Instructions [PDF-435K]
Form 143 - Detail Listing of Securities Held Under Safekeeping  [Excel-22K]
Form 440 - Certificate on Advertising  [PDF-65K]
Form 450 - Affidavit Covering Finance Committee  [PDF-42K]
Form 460 - Schedule of Miscellaneous Investments - Annual Statement  [PDF-24K]
Form 470 - Schedule of Miscellaneous Investments - Quarterly Statement  [PDF-26K]
Form 480 - Reconciliation and Summary of Assets and Reserve Requirements [Excel-28K]
Form 495 - Kentucky Supplemental Schedule  [Excel-25K]
NAIC Checklist for Health [PDF-904K]
 
Life, Accident and Health (Foreign) Back to top
Annual Statement and Other Instructions [PDF-435K]
Form 440 - Certificate on Advertising  [PDF-65K]
NAIC Checklist for Life [PDF-974K]
 
Life, Accident and Health (Domestic) Back to top
Affidavit Covering Finance Committee (Form 450) [PDF-14K]
Annual Statement and Other Instructions [PDF-435K]
Form 143 - Detail Listing of Securities Held Under Safekeeping  [Excel-22K]
Form 440 - Certificate on Advertising  [PDF-65K]
Form 460 - Schedule of Miscellaneous Investments - Annual Statement  [PDF-24K]
Form 470 - Schedule of Miscellaneous Investments - Quarterly Statement  [PDF-26K]
Form 480 - Reconciliation and Summary of Assets and Reserve Requirements [Excel-28K]
NAIC Checklist for Life [PDF-974K]
 
Property & Casualty (Domestic) Back to top
Annual Statement and Other Instructions [PDF-435K]
Form 143 - Detail Listing of Securities Held Under Safekeeping  [Excel-22K]
Form 440 - Certificate on Advertising  [PDF-65K]
Form 450 - Affidavit Covering Finance Committee  [PDF-42K]
Form 460 - Schedule of Miscellaneous Investments - Annual Statement  [PDF-24K]
Form 470 - Schedule of Miscellaneous Investments - Quarterly Statement  [PDF-26K]
Form 480 - Reconciliation and Summary of Assets and Reserve Requirements [Excel-28K]
NAIC Checklist for Property [PDF-931K]
Schedule of Miscellaneous Investments (Form 460) [PDF-19K]
Schedule of Miscellaneous Investments (Form 470) [PDF-19K]
 
Property & Casualty (Foreign) Back to top
Annual Statement and Other Instructions [PDF-435K]
Form 440 - Certificate on Advertising  [PDF-65K]
NAIC Checklist for Property [PDF-931K]
 
Title (Foreign) Back to top
Annual Statement and Other Instructions [PDF-435K]
Form 440 - Certificate on Advertising  [PDF-65K]
NAIC Checklist for Title [PDF-848K]
 
Assessment Fire Back to top
Assessment Fire Annual Statement Blank [Excel-167K]
Assessment Fire Annual Statement Instructions [PDF-418K]
Assessment Fire Check Remittance Form [PDF-97K]
 
Risk Retention Groups, Accredited Reinsurers Back to top
Form 365 - Registration for Accredited Reinsurers  [PDF-48K]
 
Other Approved Reinsurers, Surplus Lines Back to top
Form 370 - Registration for Other Approved Reinsurers  [PDF-34K]
Form 800 - Service of Process [PDF-52K]
Form 916 - Surplus Lines Insurer Information Sheet  [PDF-46K]
OAR, SL Check Remittance Form [PDF-80K]
Surplus Lines Eligibility Requirements [PDF-135K]
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