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Texas Department of Insurance
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Captives - Company Licensing and Registration Forms

If the form is a fillable PDF, learn how to enable all fillable form features.

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