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Captive Applications & Forms

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Here is a list of necessary licensing and redomestication application forms and filing requirements:

  1. Captive Application Instructions and Filing Requirements
  2. Captive Insurance Company Application form
  3. Rules and Laws regarding Application
  4. NAIC Biographical Affidavit
  5. NAIC Uniform Consent to Service of Process Form, if applicable
  6. Captive Management Application – No person shall act as an insurance manager or reinsurance intermediary for captive business in or from within this State without the authorization of the Commissioner. 23 CAR § 29-110
  7. Actuary Application – The individual who certifies as to the adequacy of reserves shall be approved by the Commissioner and shall be a Fellow of the Casualty Actuarial Society or a member in good standing of the American Academy of Actuaries. 23 CAR § 29-103
  8. CPA Application – Any independent certified public accountant retained by a company to conduct its annual audit shall make application to the Commissioner for authority to act as an independent certified public accountant for captive insurance companies. 23 CAR § 29-104
  9. Captive Insurer Redomestication Application (Coming Soon)
  10. List of Approved Captive Managers
  11. List of Approved Independent CPAs for Captives