Due to the current state of emergency, we are unable to meet in person with the public. However, we will be able to provide you with the service you need by phone or by email.
The office will be closed Monday, May 30th, in observance of Memorial Day.
Major Disaster Declaration Approved for Delaware
Hurricane Ida: Constituents may call 1-800-621-3362 or TTY 1-800-462-7585. Hours: 7 a.m. to 11 p.m. ET, 7 days a week
Website Info: DisasterAssistance.gov and FEMA.gov/disaster/hurricane-ida
Below is a list of Conditional License Application Forms:
Conditional License Application (A-1) Form Updated as of 3/23/2022
• Documents List for Conditional License Application A-1
Conditional License Application (A-2) Form Updated as of 3/23/2022
• Documents List for Conditional License Application A-2
Conditional License Cover Sheet Updated as of 3/23/2022
Below is a list of Captive 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 Revised 2/18/2020
Form B-2 — Declaration Affidavit of Financial Institutions as Trust Trustees
Form C-1 — Account Bank Balance Confirmation Form Revised 5/19/2022
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 Updated as of 6/7/2021
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 as of 4/28/2022
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 10/22/2021
Form H-1 — Dissolution Request Cover Sheet for Standalone Captive
Form H-2 — Dissolution Request Cover Sheet for Series Captive
Related Topics: Captive Insurance, Conditional License Application, Delaware Captive Insurance Program, DOI, forms