For Insurers

Depository and dividend forms

Insurers must submit depository and dividend forms to the Office of the Insurance Commissioner (OIC) in order to create, deposit, or withdraw funds from a trust account, or to notify the OIC of a dividend.


This office does not provide hard copies of the deposit or withdrawal request forms, or the depository agreements. You can find links to these forms below or request them via a message to Company Supervision. The forms must be presented to this office after both the company and bank have signed in the appropriate places and all pertinent information has been entered.

Committee on Uniform Security Identification Procedures (CUSIP) numbers are needed to identify the securities on deposit. Please provide detailed information of the security as required on the deposit and withdrawal-request forms.

Any withdrawal or transfer of funds or securities held on deposit must be approved in writing by this office before the actual transfer.


Submit forms to:

Company Supervision
Office of the Insurance Commissioner
P.O. Box 40255
Olympia, WA 98504-0255