Renewal Forms



To renew your registration, please submit the following by September 1, 2019.

 

1.              Current balance sheet and income statement. 

2.        Faithful Performance Verification Form - (renewal due September 1, 2019) W.S. § 26‑49‑103(d).

3.        Annual renewal fee of $200 payable to the Wyoming State Treasurer and mailed to the Wyoming Insurance Department, 106 East 6th Avenue, Cheyenne, WY 82002.
4.        A complete itemized listing of service contract forms including form name, form number and edition date.
5.         If you have changed insurers, please include a copy of the new reimbursement liability policy for approval. 

 

PLEASE NOTE: The Department must be notified at least 45 days prior to any changes to the reimbursement liability policy.  A copy of the amended policy must be submitted for Department review and approval.
 
NOTICE: 

In order to do business in Wyoming you are required to be registered with the
Wyoming Secretary of State and maintain that registration. Please contact their office at (307)
777-7311 for registration information. Registration will be verified at renewal; if you are not in
compliance, your service contract provider registration will not be renewed.

If you have any questions, please contact Tammy Higgins at (307) 777-6884, or email
tammy.higgins@wyo.gov.