Certificate of Authority Renewal Form - Captive Insurance Company
Pursuant to District of Columbia Code Section 10 (d) of the Captive Insurance Company
Emergency Act of 2004, all licensed captive insurance companies shall renew its Certificate of
Authority annually not later than April 30th of each year.
The annual company renewal fee is $300.00. Checks should be made payable to the DC Treasurer. Please send a copy of this renewal form with the payment. All renewal requests must be received at the address below as soon after March 1 as possible, but no later than April 30.
Renewal Mailing Address
PO Box 92180
Washington, DC 20090-2180
Please send a copy of this Renewal of Certificate of Authority Form and a copy of the
check to Joyce Lewis, via email at email@example.com .