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Department of Insurance, Securities and Banking

Certificate of Authority Renewal Form - Captive Insurance Company

Wednesday, January 19, 2022

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.  

Renewal Procedure

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

DC Treasurer Insurance Bureau 
PO Box 712180 
Philadelphia, PA 19171-2180

Please send a copy of this Renewal of Certificate of Authority Form and a copy of the check to Hawi Chibessa via email at [email protected].