The TPA Application (Form 1030) must be signed by the president if the administrator is a corporation; a partner if the administrator is a partnership and the individual proprietor in the case of a sole proprietorship. The information furnished on the application must be given under oath. The application must disclose a contact person.
The licensing fee is $100. The check should be made payable to the South Carolina Department of Insurance.
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 (Form 1029). 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 SCDOI. 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.
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.