Applications & Forms
Captive Formation
Formation, Oversight, and Examination Process [pdf]
Index for Captive Application [pdf]
Captive Insurance Company License Application [pdf] (Required Adobe 9 or higher)
Protected Cell Captive Insurance Company Individual Cell Application [pdf]
Dividends and Distributions Request Form [pdf]
(NAIC) Biographical Affidavit for Risk Retention Groups only [pdf]
(TN) Biographical Affidavit for all other applications [pdf]
Irrevocable Letter of Credit [pdf]
(NAIC) Service of Process Form [pdf] (for Risk Retention Groups only)
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
2023 - Annual Captive Filings Memo [pdf]
2023 – Annual Statement Package for non RRGs (due March 15) [pdf]
2023 – Annual Statement Package for RRGs (due March 1st) [pdf]
Welcome to CORE memo [pdf]
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