Licensing Center

To access the electronic forms indicated in this section, you must have Adobe Reader version 7.0 or higher. If your computer operating system will not accommodate this version please contact Eric Showgren of the Utah Insurance Department at (801) 537-9174.

Approved UID Captive Insurance Company Provider Application Forms

Provider Application Forms

• UID Captive Management Firm Application
• UID Captive Actuary Application
• UID Authorized CPA Application

Approved Captive Insurance Company Providers

• Management Firms
• Actuarial Firms
• Certified Public Accountants

Captive Insurance Company Application Process

In order to obtain an application, interested parties must first complete some preliminary steps as follows:

1. Conduct a self assessment to make a preliminary determination as to whether a captive insurance company is right for your business,
2. Obtain a qualified consultant to provide advice and conduct a feasibility study,
3. Meet with the Department to obtain guidance and buy-in on the initial plan, and
4. Make an on-line request to the Department for an application.

It is imperative that these steps be completed before an application is filled out. Because these steps are so critical to the success of any captive, the Department limits access to the captive application forms until it is satisfied that this process has been completed. After we have met with the principles and the initial plans appear feasible, access to the application process will be provided by email.

Captive Insurance Company Renewal Forms

• UID Captive Insurance Company Annual Statement Form (pdf document)

Note: A Utah Captive Insurance Company will be renewed unless its certificate of authority is revoked or the company surrenders the certificate of authority. During the online renewal process the captive will be able to pay to renew and print a certificate of authority. Each authorized captive will receive an invoice for renewal fees and instructions to renew and print its certificate on line.

Annual Statement of Economic Benefit Form

• Annual Statement of Economic Benefit Form

Click on the active link to access the form. This form is required to renew a certificate of authority to act as a captive insurance company in Utah.