Our office should be notified in writing immediately within 30 days of any of the following changes:

• Change of mailing address/change of name. Report on FIS 0865 Jurat Page and include amended articles of incorporation (or other applicable documents). There is no charge. A new Certificate of Authority will be created automatically if a name change occurs.
  
  
• Change of person or address designated to receive service of process. Report on FIS 0860 Consent to Service.
  
  
• Adoption of any assumed name/dba. Report on FIS 0865 Jurat Page accompanied by a true copy of the dba filing.
  
  
• Change in articles of incorporation or bylaws, Report on FIS 0865 Jurat Page accompanied by a true copy of the filing
  
  
• Change of the corporate entity or federal identification number. Change of the corporate entity, such as a merger or re-incorporation, is deemed to be significant. If new officers, directors, or stockholders of 10% or more result from a merger, each new individual or entity must complete a form FIS 0862. A change of FEIN requires a new FIS 0861 Third Party Administrator Application for Certificate of Authority, accompanied by new forms and fees for the new entity.
  
  
• Change in officers, directors, or shareholders holding 10% or more of the TPA's stock. An FIS 0862 Affiliation Statement will be required if one has not already been filed for the individual(s) or entities.
  
  
• Change in status of the business. For example, if you are going to cease acting as a TPA, inform this office in writing.