(1) An applicant shall use the following forms, available on the department's website, https://insurance.utah.gov/captive, when applying for a certificate of authority for a new company:
- (a) Application to Form a Captive Insurance Company;
- (b) Appointment of the Insurance Commissioner for the State of Utah as Attorney to Accept Service of Process;
- (c) Bank Capitalization Confirmation Form;
- (d) Biographical Affidavit for Captive Insurance Company;
- (e) Captive Insurance Company Annual Statement Form;
- (f) Statement of Economic Benefit to the State of Utah; and
- (g) Utah Approved Irrevocable Letter of Credit.
(2) An applicant shall use the following forms, available on the department's website, https://insurance.utah.gov/captive, when applying to become an approved captive insurance company service provider:
- (a) Application for Placement on Approved Captive Insurer Management Firm List;
- (b) Application to Certify Loss and Expense for Captive Insurance Companies Captive Actuary Application; and
- (c) Application for Authorization as an Independent Certified Public Accountant for Captive Insurance Companies.
- (3) A company, except as provided under Subsection R590-238-4(2)(b), shall use the Captive Insurance Company Annual Statement Form.
- (4) A company shall file a Statement of Economic Benefit to the State of Utah form with its initial application and for each year.
KEY: captive insurance
Date of Last Change: February 9, 2026
Notice of Continuation: May 2, 2022
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-37-106