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]

(TN) Biographical Affidavit [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

2024 - Annual Captive Filings Memo [pdf]

2024 – Annual Statement Package (due March 15) [pdf]

Welcome to CORE memo [pdf]

Annual Statement Certification [pdf]

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