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Department of Insurance, Securities and Banking

Biographical Affidavit

Wednesday, April 12, 2023

A biographical affidavit (for risk retention groups only) must be completed by each director, officer, captive manager, and owner who will own more than 10 percent of the outstanding shares of the applicant. Answer each question on this application and provide a detailed explanation where necessary. Do not leave a question blank. Incomplete applications will be returned. Applicants shall submit this completed application to: The DC Department of Insurance, Securities and Banking, 1050 First St., NE, Suite 801 Washington, DC 20002, Attn: Risk Finance Bureau or via email to [email protected]