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Department of Insurance, Securities and Banking

Captive Insurance Company Application

Instructions: 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. Effective March 16, 2020 and until further notice, applications should be submitted electronically and hard-copy applications are not required. The electronic application should be signed and should include a detailed table of contents and should be in a single PDF document with bookmarks. Also submit the proforma financial template in the excel format. The application and proformas should be e-mailed to [email protected] with a copy to [email protected].

The 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. If paying by check, a copy of the check should be included in the PDF application and the check should be submitted to the:

DC Department of Insurance, Securities and Banking 
Attn: Ms. Anu Andrew, Insurance Licensing Specialist, Risk Finance Bureau 
1050 First Street, NE, Suite 801 
Washington, DC 20002.

Payment can also be accepted via ACH or wire transfer. Please contact Ms. Anu Andrew at [email protected] for ACH and wire instructions.