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Texas Department of Insurance
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Captives - Company Licensing and Registration Forms

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TDI Form Number Description File Format Language
FIN180 Certificate of Authority Application for a Captive Insurance Company
Certificate of Authority Application for a Captive Insurance Company, either a Texas start up or a company wishing to redomesticate to Texas
PDF English
FIN181 Biographical Affidavit for Captive Insurance Company
Biographical Affidavit form for individuals that oversee management of the Captive Insurance Company
PDF English
FIN182 Financial Projections for Captive Insurance Company
Financial Projections Excel Workbook for Captive Insurance Company
EXCEL English
FIN184 Appointment of Agent for Service of Process for a Captive Insurance Company
Notarized form appointing an agent for service of process for a captive insurance company
PDF English
FIN185 Moving a Captive Insurance Company's Books and Records Out of the State of Texas Under Texas Insurance Code, Section 803
Form and requirements for a captive insurance company wishing to move its books, records, accounts, and/or principle office(s) outside the state of Texas
PDF English
FIN186 Captive Insurance Company Officers' Certification and Attestation Certificate of Filing
Certification by a Captive Insurance Company's Officers in regards to true and accurate information submitted with application
PDF English
FIN321 Company Licensing Fee Transmittal Form
Company Licensing and Registration Fee Transmittal Form to be submitted with filings.
PDF English

For more information, contact: CompanyLicense@tdi.texas.gov