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Below is a list of Conditional License Application Forms:
Conditional License Application (A-1) Form Updated as of 4/1/2024
• Documents List for Conditional License Application A-1
Conditional License Application (A-2) Form Updated as of 2/15/2024
• Documents List for Conditional License Application A-2 Updated as of 3/27/2024
Conditional License Cover Sheet Updated as of 7/25/2023
Below is a list of Captive Forms that can be found on this Captive website:
Form A-1 — Captive Application for Certificate of Authority Revised 3/28/2024
Form A-2 — Series Application Updated as of 3/27/2024
Form B-1 — Biographical Affidavit Revised 9/25/2024
Form B-2 — Declaration Affidavit of Financial Institutions as Trust Trustees Revised 7/25/2023
Form C-1 — Account Bank Balance Confirmation Form Revised 7/25/2023
Form C-2 — Sample Owner’s Request for Balance Confirmation
Form C-3 — Sample Surplus Note
Form C-4 — Sample Letter of Credit Revised 7/25/2023
Form D-1 — Designation for Receipt of Delaware Documents
Form D-2 — Designation for Receipt of Service of Process Updated as of 6/7/2021
Form E-1 — Actuarial Authorization Application Revised 7/11/2024
Form E-2 — Captive Manager Authorization Application Revised 4/13/2023
Form E-3 — Certified Public Accountant Authorization Application Revised 4/13/2023
Form F-1 — Annual Report for Pure Captives, Core LLCs and Series Captive Insurance Companies Updated as of 3/31/2025
Form F-2 — Annual Report for Other Captive Entities Updated as of 4/8/2020
Form F-3 — Quarterly Captive Report Updated as of 2/25/2019
Form G-1 — Dormant Status Request Form Updated as of 11/02/2023
Form H-1 — Dissolution Request Cover Sheet for Standalone Captive Updated as of 11/16/2023
Form H-2 — Dissolution Request Cover Sheet for Series Captive Updated as of 11/16/2023
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