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Home > Insurance Division > Captive Corner > Admission Application Packet
NJ Captive Admission Packet (For Forming a Captive in NJ)
 
Forms
Note: Most of the documents below are "fillable" PDFs which can be opened with Adobe Acrobat Reader and filled out directly on the screen. Please print the completed forms and sign as needed. See Forming a Captive in NJ to schedule a meeting with the Department before submitting any application. Captive Insurance
NJ DOBI
20 W. State St.
PO Box 325
Trenton, NJ 08625-0325
1.

Captive Admission Application

2. Irrevocable Letter of Credit
3. Strategic Business Plan
4. Biographical Affidavits
5. Designee for Receipt of Service of Process
6. Designee to Receive Department Documents

In addition, the applicant must also submit the following to the Department with the Admission Application Packet:
  Check mark

Bylaws

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Articles of Incorporation or the equivalent for non-corporate forms of business

  Check mark Pro Forma Financial Projections (5 year expected and 5 year adverse)
  Check mark Actuarial Feasibility Study
  Check mark Statement of Benefit to New Jersey
  Check mark Minimum Capital and Surplus Guidelines
  Check mark Such other statements and descriptions as are provided for in P.L. 2011, C.25 (N.J.S.A. 17:47B-1et. Seq.)
  Check mark Statement of net worth
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New Jersey Department of Banking and Insurance