Online Certificate of Compliance Request

Please read the important information below prior to completing your request. Following these instructions will help you and the Ohio Department of Insurance fulfill your request as expeditiously as possible.

This form should only be used and is only applicable to request a Certificate of Compliance

Complete all required fields below. Required fields are marked in red.
ODI will send an invoice for the amount of $60.00 (per certificate) to the contact person or billing person.
If you have further questions, please call the Office of Risk Assessment at (614) 644-2647 or email risk.assessment@insurance.ohio.gov

Insurer's Information

Insurer's Name: *

Tax ID or NAIC Number: *

Number of Copies: *

If requesting certificates for more than one insurer, enter additional Insurer's Name, Tax ID or NAIC Number, and Number of Copies in the field here:

Contact Information

Name: *

Company Name: *

Address Line 1: *

Address Line 2:

City: *

State: *

Zip Code: *

Daytime Phone: *

Email: *

Billing Information (If different from Contact Information)

Name:

Company Name:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Captcha: *

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