Forms

Captive insurer forms

• Captive Insurance Company Application: fillable form or pdf
• Captive Insurer Certificate of Authority Renewal: pdf (fillable form)
  
• Captive Insurer Reinsurance Exhibit: fillableform or pdf
• Permit to Organize Captive Insurer With or Without Capital Stock: fillable form or pdf
• Designation of Registered Office and Registered Agent in Oregon: fillable form or pdf
• Oregon Approved Irrevocable Letter of Credit: fillable form or pdf
• Bank Deposit Confirmation: fillable form or pdf
• Captive Insurance Company Feasibility Study: fillable form or pdf
• Captive Insurance Annual Statement: fillable form

Provider forms

• Placement on Approved Captive Insurer Management Firm List: fillable form or pdf
• Application to Certify Loss and Expense Reserves for Captive Insurers: fillable form or pdf
• Authorization as an Independent Certified Public Accountant for Captive: fillable formor pdf