This form is for Illinois Division of Insurance Freedom of Information Requests only!

Freedom of Information Act Request Form
Financial and Professional Regulation, Division of Insurance

IMPORTANT NOTICE: Disclosure of public records is required to comply with the provisions of the Illinois Freedom of Information Act and Public Records Rule. Click here to view a general categorical list of records.

To request a copy of a public record, please type in the information required below along with a description of the records(s) sought. Be as specific as possible in describing the document requested, identify the date or time span for the records sought, and include any additional information which may assist the Division with the identification of the record(s). Please note that an asterisk (*) indicates a required field. We also require either a work phone number or a home phone number.

The undersigned requester, pursuant to the provisions of the Illinois Freedom of Information Act, hereby requests access to public information maintained by the Division as described below.

*I understand that copies are $1.00 per page.  
*First Name: *Last Name:
  SSN/FEIN/Tax ID:
  Company Name:
*Mailing Address:
  Address (continued):
*City: *State: *Zip:-(Last four if known)
  E-mail Address:
(IDOI cannot e-mail requested material)
*Work Phone:(or) ()-   ext.(w/Area Code)
*Home Phone: ()-
*Records Requested:  

*Do you want to inspect the records requested?  YesNo
*Do you want copies of the records requested?   YesNo