Depositary/Dividend Forms
Remember that CUSIP numbers are needed to identify the securities on deposit. Also, any transfer of funds or securities held on deposit must be approved in writing by us before the actual transfer.
- Deposit Request - State Deposit Account (PDF 63Kb)
- Depositary Agreement (PDF 52Kb)
- Withdrawal Request - State Deposit Account (PDF 66Kb)
- Notification of Dividend from Washington Health Carriers (PDF 70Kb)
- Notification of Dividend from Washington Insurers (PDF 31Kb)
Submit forms to:
Company Supervision Division
Office of the Insurance Commissioner
PO Box 40259
Olympia, WA 98504-0259
Questions?
Susan Miller
Email: SusanM@oic.wa.gov
Phone: (360) 725-7212