Utah Admin. Code R590-238-19 - Authorized Forms
(1) An applicant
shall use the following forms, available on the department's website,
https://insurance.utah.gov/captive,
when applying for a certificate of authority for a new company:
(a) Application to Form a Captive Insurance
Company;
(b) Appointment of the
Insurance Commissioner for the State of Utah as Attorney to Accept Service of
Process;
(c) Bank Capitalization
Confirmation Form;
(d) Biographical
Affidavit for Captive Insurance Company;
(e) Captive Insurance Company Annual
Statement Form;
(f) Statement of
Economic Benefit to the State of Utah; and
(g) Utah Approved Irrevocable Letter of
Credit.
(2) An applicant
shall use the following forms, available on the department's website,
https://insurance.utah.gov/captive,
when applying to become an approved captive insurance company service provider:
(a) Application for Placement on Approved
Captive Insurer Management Firm List;
(b) Application to Certify Loss and Expense
for Captive Insurance Companies Captive Actuary Application; and
(c) Application for Authorization as an
Independent Certified Public Accountant for Captive Insurance
Companies.
(3) A company,
except as provided under Subsection
R590-238-4(2)(b),
shall use the Captive Insurance Company Annual Statement Form.
(4) A company shall file a Statement of
Economic Benefit to the State of Utah form with its initial application and for
each year.
Notes
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