- The TPA Application and fee of $100 must be completed on NIPR. The information furnished on the application must be given under oath. The application must disclose a contact person.
There is additional information that will need to be submitted to the SC Department of Insurance to complete your application. Please fill out this form and email to the Specialty Licensing team. You will need to provide the following as well.
- Provide original or certified copies of partnership agreements; articles of incorporation, certified by the Secretary of State; Certificate of Good Standing / Certificate of Authority from the South Carolina Secretary of State; trade name certificate; trust agreement; shareholder agreement; and other applicable documents and amendments to those documents.
- Provide a list of the names, addresses, and official titles of positions held by individuals who are responsible for the conduct of the Administrator.
- A Biographical Affidavit (Form 1000c) should be completed on each official officer / director listed above.
- A certified copy of the business certificate from the Clerk of Court must be filed in the county where domiciled if the administrator plans to use a "d.b.a" name.
- File a Administrator Bond. A $75,000 surety bond must be issued by a South Carolina licensed insurer and must include a 30-day notice of cancellation to the SC DOI. In lieu of a bond, letters of credit or certificates of deposit in which deposits are guaranteed by the Federal Savings and Loan Insurance Corporation to meet the financial obligation. Under no circumstances will this requirement be waived. At renewal the amount may change due to collection of premiums.
- Provide a copy of your financial statement (two most recent calendar years), which must include a balance sheet and income statement. An officer of the company must sign the financial statement.
- Provide a copy of the written service agreement between the administrator and insurer or client. If the applicant is currently not acting as an administrator, a statement indicating that no written agreement has not been executed should be submitted.