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 |
English | |
| FIN181 |
Biographical Affidavit for Captive Insurance Company Biographical Affidavit form for individuals that oversee management of the Captive Insurance Company |
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 |
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 |
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 |
English | |
| FIN321 |
Company Licensing Fee Transmittal Form |
English |
For more information, contact: CompanyLicense@tdi.texas.gov