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Governmental Insurance Disclosure


Governmental Insurance Disclosure

why is this important?

If you are a New York licensed insurance agent, broker, adjuster, consultant or intermediary who received or shared in compensation for insurance services/coverages for a governmental unit, you must file a Governmental Insurance Disclosure Statement with the NYS Department of Financial Services and the senior official of the governmental unit.

This does not apply to MGAs and title insurance agents for certain named insureds.


when is the deadline?

​​The deadline is April 15 each year for the activity in the previous calendar year.​

What is considered a governmental unit?

  • ​State of New York & its agencies/departments
  • Public authorities
  • Public benefit corporations
  • Counties, cities, towns, villages & subdivisions

Where can i find the form?

​​​You can download the form below.