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Uniform Certificate of Authority Expansion Application
Statement of Withdrawal
Louisiana State Specific Items

For a Uniform Certificate of Authority Corporate Amendment for withdrawal from Louisiana there is one state specific item. In addition of the requirements of the Uniform Application, the insurer must complete and submit the UCAA Statement of Withdrawal Louisiana Specific Addendum.


If the application is submitted electronically using the National Association of Insurance Commissioner Uniform Certificate of Authority electronic submission process or via email to companyapps@ldi.state.la.us there are no “hard copy” filing requirements for the application.  However, on all imaged documents that require notarization or certification, the notarization or certification seal must be clearly visible on the image.


If the insurer would like to request release of the statutory deposit, a specific written request for that release must be submitted.  The request must be accompanied with a completed Oath of Liabilities.