Skip to main content
ATTN PRODUCERS AND CONSUMERS RE: NPN Override for Marketplace Plan Enrollment and Plan Changes

NCDOI Advisory Memo relating to NPN Override for Marketplace Plan Enrollment Read memo

An official website of the State of North Carolina An official website of NC How you know

State Government websites value user privacy. To learn more, view our full privacy policy.

Secure websites use HTTPS certificates. A lock icon or https:// means you’ve safely connected to the official website.

Utility Menu
  • ABOUT
  • NEWS
  • CONTACT
  • CAREERS
  • NC.GOV
Home

Main menu

  • Consumers
  • Assistance/Complaints
  • Insurance Industry
  • Licensees
    • Licensees
    • Insurance Producer and Adjuster Licensing
    • Bail Bondsmen Licensing
    • Captive Insurance
    • Collection Agency Licensing
    • Company Licensing and Registration
    • Continuing Care Retirement Communities (CCRC)
    • Individual Self-Insured Workers' Compensation Licensing
    • Insurance Business Entity Licensing
    • Insurance Company and County Farm Mutual Appointments and Terminations
    • Life and Health Licensing
    • Motor Club Licensing
    • Nonadmitted Domestic Surplus Lines Insurers Licensing
    • Pharmacy Benefit Manager Licensing
    • Pre-Licensing Education Providers
    • Premium Finance Company Licensing
    • Professional Employer Organizations (PEOs)
    • Surplus Lines Licensing
    • Third Party Administrator Licensing
    • Viatical Settlement Provider Licensing
    • Home Inspector Licensure Board
    • OSFM Licensees
  • Fraud Control
  • About DOI

Utility Menu

  • ABOUT
  • NEWS
  • CONTACT
  • CAREERS
  • NC.GOV
  1. Home
  2. Licensees
  3. Professional Employer Organizations (PEOs)

Professional Employer Organizations - Forms

Forms

  • Form 01-132-15 Authority For Release Of Information
  • PEO-01 Application
  • PEO-02 Biographical Affidavit
  • PEO-03 Unconditional Cross Guaranty
  • PEO-04 Power Of Attorney (Service Of Legal Process)
  • PEO-05 Obligations Attestation
  • PEO-06 CEO and CFO Fin Stmt Attest
  • PEO-07 Power of Attorney (Assign Securities)
  • PEO-08 Surety Bond
  • PEO-08a Surety Bond Endorsement (Name Chg)
  • PEO-08b Surety Bond Endorsement (Amount Chg)
  • PEO-09 Irrevocable Letter of Credit
  • PEO-10 Notification of Change
  • PEO-10a Notification of Change - De Minimis Registration
  • PEO-13 Notification of Change in WC Ins or HB Plan
  • PEO-14 Unconditional Guaranty Agreement
  • PEO-15 Fingerprint Instructions
  • PEO-16 Corporate Resolution of Guarantor
  • PEO-17 Workers' Comp Attest
  • PEO-18 De Minimis Registration Notification
  • PEO-19 De Minimis Registration Annual Notice
  • PEO-22 Parental Guaranty for PEO

Questions

If you have any questions please contact Christine Williams at 919-807-6612 (Christine.Williams@ncdoi.gov).

Side Nav

  • Professional Employer Organizations (PEOs)
    • Annual/Misc. Filing Requirements for PEOs
    • How to Apply for De Minimis Registration
    • How to Apply for Individual/Group PEO
    • How to Submit Fingerprints for PEO
    • PEO Forms

Contact Us

North Carolina Department of Insurance

Physical Address:
3200 Beechleaf Court
Raleigh NC 27604

Mailing Address:
NC Department of Insurance
1201 Mail Service Center
Raleigh NC 27699-1201


Toll Free 855-408-1212

Agent Services: 919-807-6800

Contact NCDOI
Employee Directory
Careers at NCDOI
Calendar

Follow Us on Facebook

Follow Us

Network Menu

  • nc.gov
  • Website Feedback
  • Accessibility
  • Disclaimer & Terms of Use
  • Privacy Policy
  • Open Budget
Hosted on Digital Commons