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Insurance Division - Captive Insurance

IV. General Licensing Instructions

Captive Information

At the bottom of this page are links to application forms for admission as a captive insurance company together with a sample letter of credit form and biographical affidavit form.

The application form must be filled out in its entirety and when submitted should include all material requested together with an application fee of $675.00.  No incomplete package of material will be accepted.

If letters of credit are used to meet capital and surplus requirements an Irrevocable Letter of Credit must be adhered to by the institution issuing the letter of credit.  Copies should be made and enclosed as required by the application.  Each affidavit must be filled out in its entirety and no substitute for this form will be accepted.


Financial Regulation (Select an Accountant)


Prior to March 1st of each year (March 15th for Pure and Industrial Insured Captives)all companies shall submit to the commissioner a report of its financial condition, verified by oath of two (2) of its executive officers.  You may ask the Department if your CPA is currently approved.


Certification of Reserves (Select an Actuary)


Reserves and loss expense reserves be certified by a Fellow of the Casualty Actuarial Society, a member in good standing of the American Academy of Actuaries or an individual who has demonstrated his competence in loss reserve evaluation and has been approved by the Commissioner.  It is incumbent upon the applicant to select a member or individual who meets the requirements of this regulation.  You may ask the Department if your Actuary is currently approved.


Review Firm


All applications may be reviewed by review firms appointed by the Commissioner. The firms' duties are of an advisory nature only and final approval or disapproval of an application will be made by the Commissioner only.


Captive Blank


Pure and Industrial Insured captives will file an annual statement on a Tennessee Captive Insurance Company blank established by the Commissioner.  Association captives and Risk Retention Groups will file an annual statement on the NAIC blank currently in use by the insurance industry.

Location Of Captive Records


All books, records, and other information necessary for an examination shall be located in Tennessee.


Application Turnaround Time


Approximately 30 Days from Receipt


Click Here to Get Applications and Forms