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of the Commonwealth of Pennsylvania

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    Pennsylvania Insurance Department

    Holding Company Related Financial Filing Requirements

    Filing Requirements and Related Information

    Filing Forms
    Form A - Acquisition of Control of, or Merger With, a Domestic Insurer (PDF)
    Form B - Insurance Holding Company System Annual Registration Statement (PDF)
    Form C - Summary of Registration Statement (PDF)
    Form D - Prior Notice of a Transaction (PDF)
    Form E - Pre-Acquisition Notification Statement (PDF)
    Form F - Enterprise Risk Report (PDF)
    Filing of Intention to Pay a Dividend or Other Distribution Checklist (PDF)

    Legal Entity Grid (Excel) -The Legal Entity Grid should contain complete and up-to-date information for every legal entity in the group as a separate line on the grid.

    If you are required to file Form B, Holding Company Registration Statement, and PA is the lead regulator of the group, the Legal Entity Grid must be received by July 1. After the initial submission the Grid should be updated annually. 

    Filing Fees
    All applicable filing fees must be remitted at the time of filing.