STATE OF WASHINGTON - Download Now DOC

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					                                                    STATE OF WASHINGTON
     MIKE KREIDLER                                                                                     Phone: (360) 725-7202
STATE INSURANCE COMMISSIONER                                                                            Fax: (360) 586-2022




                                                              OFFICE OF
                                             INSURANCE COMMISSIONER


                                           RISK PURCHASING GROUP
                                             Application Instructions

           Applying for Registration as a Risk Purchasing Group in Washington

           The application file consists of the application, service of process form, and a link to the applicable
           Washington statutes and regulations. [While it is the case that generally speaking, the Washington law
           mirrors the federal law of 15 USC §3901 et seq. (the LRRA of 1986), there are some differences.]
           Should you have questions regarding the application, the application process, or the applicable law,
           please contact us as soon as possible.

           The application packet is designed to be downloaded and saved to your hard drive. You should be able to
                                 ®
           “tab” through the Word application document and enter necessary information, which you will then save
           and print. There is no application or annual fee imposed for registration.


           After signature by the authorized officer, the application form, along with all required documentation and
                                                                      ®
           any cover letter need to be scanned into a single Adobe pdf document for electronic submission via
           email.
                The email subject line must state “Purchasing Group Application of <your company’s legal
                    name>”.
                The email address to be used is CompanySupervisionFilings@oic.wa.gov.
                Attach the pdf to the email and send.


           Questions?
           For all questions or requests for additional information, please contact the Company Licensing Specialist:
                    .
                Susan Baker at (360) 725-7232 or by email at SusanB@oic.wa.gov.




                                                     Company Supervision Division
                                           Mailing Address: PO Box 40259 ● Olympia, WA 98504-0259
                                         Street Address: 5000 Capitol Boulevard ● Tumwater, WA 98501
                                                                 Rev 03/2012

				
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