Renewal Forms



INSTRUCTIONS FOR SERVICE CONTRACT PROVIDER RENEWAL

Please submit the following by September 1:
  1. Current balance sheet and income statement.  
  2. The Faithful Performance Verification Form, documenting your compliance with the requirements of 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.  Please return a copy of the invoice with your check.  We do not have an electronic payment option at this time.
  4. An itemized listing of service contract forms including form name, form number and edition date.
  5. Copies of any new reimbursement policies if the insurer has changed.
Once registered, Service Contract Providers are allowed to market service contracts without submitting forms for review or approval by the Department.  All service contracts and reimbursement insurance policies must comply with Wyoming laws, regulations and Department policy.  Please reference the Service Contract and Reimbursement Policy Checklist found at our website, http://doi.wyo.gov 

Service Contract Providers should be aware of the record keeping requirements in W.S. §26-49-107. As provided in W.S. §26-49-110, the commissioner may conduct examinations and request copies of accounts, books and records concerning service contracts.

NOTICE:  In order to do business in Wyoming, the provider is required to register with the Wyoming Secretary of State and maintain that registration.  Please contact their office at (307) 777-7311 or register at http://sos.wyo.gov.  Registration is verified at renewal; if you are not in compliance, your service contract provider registration will not renew.  All trade names registered with the Secretary of State must be listed on the renewal form.

If you wish to withdraw your registration, please return the invoice with a letter of explanation, including the last date that any service contracts were in force in Wyoming.  
                
                Renewal questions:              Contract and Reimbursement Policy questions:
                Tammy Higgins         Donna Stewart      (307) 777-7308
                tammy.higgins@wyo.gov donna.stewart@wyo.gov