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  1. Insurance Industry
  2. Captive Insurance
  3. Licensing Requirements and Forms

Licensing Requirements and Forms

Please find all forms and filing requirements for the licensing of North Carolina Captive Insurance Companies including domestic Risk Retention Groups below

  • Requirements for Captive Insurer License and Redomestication Applications
  • Captive Manager Application
  • Captive Insurer License Application
  • Captive Insurer Redomestication Application
  • Form C-101 Biographical Affidavit
  • Form C-103 Captive Consent to Service of Process
  • Form C-104 Financial Statement Attestation
  • Form C-105 Special Purpose Financial Captive Insurer Affidavit
  • Letter of Credit (LOC) Guideline

 

Related Content

  • Register or Renew a Foreign Risk Retention Group

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    • Captive Insurance
      • About Captive Insurance Companies
      • Forming a Captive
      • Why N.C.?
      • NC Captive Law
      • Licensing Requirements and Forms
      • Annual Filing Requirements and Forms
      • Licensed Captives
      • Captive Managers
      • Captive Regulatory Team
      • Captives Events

Contact Us

North Carolina Department of Insurance

Physical Address:
Albemarle Building
325 N. Salisbury Street
Raleigh NC 27603-5926

Mailing Address:
NC Department of Insurance
1201 Mail Service Center
Raleigh NC 27699-1201

Toll Free 855-408-1212

Agent Services: 919-807-6800

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