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The District of Columbia Insurance Regulatory Trust Fund Bureau was established pursuant to the District of Columbia Insurance Regulatory Trust Fund Act of 1993 (DC Official Code § 31-1201 et seq.) Pursuant to this act, all DC licensed insurance companies and h

Complete and return the registration application form with the required attachments. For an initial registration to be complete, all of the required information must be included. An incomplete or incorrect application will result in the return of your application and possible denial.

This form is designed to authorize the disclosure of mental health information listed below by the individual practitioner to determine entitlement of paymant of claims or reimbursement.  It is not to be used for in-patient or partial hospitalization.

Initial application for written consent to engage in the business of insurance in the District of Columbia pursuant to 18 USC section 1033 and 1034