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Captive
Insurance Program

List of Captive Forms


Below is a list of forms that can be found on this Captive website:

Form A-1 — Captive Application for Certificate of Authority

Form A-2 — Series Application

Form B-1 — Biographical Affidavit

Form B-2 — Declaration Affidavit of Financial Institutions as Trust Trustees

Form C-1 — Account Bank Balance Confirmation Form

Form C-2 — Sample Owner’s Request for Balance Confirmation

Form C-3 — Sample Surplus Note

Form C-4 — Sample Letter of Credit

Form D-1 — Designation for Receipt of Delaware Documents

Form D-2 — Designation for Receipt of Service of Process

Form E-1 — Actuarial Authorization Application

Form E-2 — Captive Manager Authorization Application

Form E-3 — Certified Public Accountant Authorization Application

Form F-1 — Annual Report for Pure Captives, Core LLCs and Series Captive Insurance Companies UPDATED

Form F-2 — Annual Report for Other Captive Entities

Form F-3 — Quarterly Captive Report


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