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Forms

Captive insurer forms

  • Captive Insurance Company Application: PDF graphic icon for PDF document file (440-4937)
  • Captive Insurer Certificate of Authority Renewal: PDF graphic icon for PDF document file (440-5000)
  • Captive Insurer Reinsurance Exhibit: PDF graphic icon for PDF document file (440-4938)
  • Permit to Organize Captive Insurer With or Without Capital Stock: PDF graphic icon for PDF document file (440-4939)
  • Designation of Registered Office and Registered Agent in Oregon: PDF graphic icon for PDF document file (440-4941)
  • Oregon Approved Irrevocable Letter of Credit: PDF graphic icon for PDF document file (440-4942)
  • Bank Deposit Confirmation: PDF graphic icon for PDF document file (440-4944)
  • Captive Insurance Company Feasibility Study: PDF graphic icon for PDF document file (440-4947)
  • Captive Insurance Annual Statement: PDF graphic icon for PDF document file (440-4948)

Provider forms

  • Placement on Approved Captive Insurer Management Firm List: PDF graphic icon for PDF document file (440-4936)
  • Application to Certify Loss and Expense Reserves for Captive Insurers: PDF graphic icon for PDF document file (440-4945)
  • Authorization as an Independent Certified Public Accountant for Captive: PDF graphic icon for PDF document file (440-4946)