Captive Applications & Forms

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 https://content.naic.org/sites/default/files/ucaa-industry-naic-biographical-affidavit.pdf
  5. NAIC Uniform Consent to Service of Process Form, if applicable http://www.naic.org/documents/industry_ucaa_form12.doc
  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. Rule 73 s 11
  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. Rule 73 s 4
  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. Rule 73 s 5 Application for CPA
  9. Captive Insurer Redomestication Application (Coming Soon)