Department of Insurance, Securities and Banking
Office Hours
Monday to Friday, 8:15 am to 4:45 pm, except District holidays
Connect With Us
810 First Street, NE, Suite 701, Washington, DC 20002
Phone: (202) 727-8000
Fax: (202) 535-1196
TTY: 711
Email:disb@dc.gov
Agency Performance
Monday to Friday, 8:15 am to 4:45 pm, except District holidays
Connect With Us
810 First Street, NE, Suite 701, Washington, DC 20002
Phone: (202) 727-8000
Fax: (202) 535-1196
TTY: 711
Email:disb@dc.gov
Agency Performance
Captive Insurance Company Application
This application shall be accompanied by a $500.00 non-refundable application review fee and a $300.00
certificate of authority fee. If the application is denied, the certificate of authority fee will be returned.
Answer each question on this application. If a question is not applicable, respond by indicating “not applicable.” Do not leave
a question blank. Incomplete applications will be returned. Submit one signed original and four copies in three-ring binders,
and include a detailed table of contents and clearly marked tabs with each copy.
Attachment(s):
| Attachment | Size |
|---|---|
 Captive_Application_updated.pdf | 306.56 KB |
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