Insurance Division - Captive Insurance
V. CAPTIVE APPLICATIONS AND FORMS
Applications and Forms
- Licensure Process
- Index Format for Captive Application
- Index Format for SPFC Applications
- Interactive Captive Insurance Company Licenses Application (Required Adobe 9 or higher)
- Biographical Affidavit
- Irrevocable Letter of Credit
Actuaries, CPA's and Manager's Applications and Forms
- Application to Certify Loss Reserves and Loss Expenses
- Application For Authorization As An Independent Certified Public Accountant
For Captive Insurance Companies - Application for Placement on Approved Captive Insurer Management Firm List
Statement Filings and Premium Tax Forms
- Captive Annual Premium Tax Form (due March 1) [pdf]
- Captive Annual Statement Form (due March 1) [pdf]
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Unless otherwise indicated, files are Adobe Reader® Files [pdf], 6.0 or higher. You may need to DOWNLOAD a free copy of Adobe Reader® be able to view these files.
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