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).

            *NEW* DOI Consumer Advocates have requested contact information for your Consumer Complaints Department. These fields have been                added to 2021 Form.

     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.

             Past-due invoices may affect your renewal status.

     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.

    Registered Service Contract Providers are allowed to market service contracts without submitting forms for review or approval by the Department.     Please reference the Service Contract and Reimbursement Policy Checklist found at our website, http://doi.wyo.gov to ensure your forms are in        compliance.

    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 maintain registration with the Wyoming Secretary of State. Forms and        information can be found at http://sos.wyo.gov.  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