Applications & Forms
Captive Formation
Formation Captive Application, Oversight, and Examination Process
Using CORE for Captive Insurance
Index for Captive Application [pdf]
Captive Insurance Company License Application [pdf]
Protected Cell Captive Insurance Company Individual Cell Application [pdf]
Dividends and Distributions Request Form [pdf]
(TN) Biographical Affidavit [pdf]
Depository Agreement [pdf]
Irrevocable Letter of Credit [pdf]
Securities Account Control Agreement [pdf]
Securities Account Control Agreement Form B [pdf]
Securities Account Control Agreement Form C [pdf]
Service Providers
Actuary Designation Form [pdf]
Captive Manager Designation Form [pdf]
Certified Public Accountant Designation Form [pdf]
Annual Statement and Premium Tax
2025 - Annual Captive Filings Memo [pdf]
2025 – Annual Statement Package (due March 15) [pdf]
Annual Statement Certification [pdf]
RRGs
NOTE: Risk Retention Groups (RRGs) should use the forms and instructions here.
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