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Applications, Forms, and Lists

applications, forms, listsELECTRONIC SIGNATURES AND NOTARIZATION

  • We allow electronic or e-signatures utilizing digital signature software and request that available software confirmations, such as e-signature certificates, be included within PDF filings.
  • For documents requiring a notarized signature it is our expectation that documents be notarized, whether original or remote.
  • Per the Vermont Secretary of State, Vermont notaries are allowed to notarize remotely (Effect. 9/15/2021; Further Extended and Expires 3/3/2024)  
  • We will accept remote documents from out of state if that state allows remote notarization.   
  • There are several technology companies that offer end-to-end remote notarization systems, which may be permitted by other states where the notarization originates.  They include, but not limited to:

Applications

For admission as a Vermont captive insurance company, you must submit an application, along with supporting forms and documentation. Take note of the additional requirements and application fees. Applications may be submitted electronically to DFR.CaptiveMail@vermont.gov.

All forms may be submitted electronically in combined single PDF unsecure format and Zip files are NOT accepted. Please see specific form and applications general instructions for further instructions and submission address.

Special Purpose Financial Insurance Companies (SPFIs) may be subject to different instructions and forms. If you are forming a Special Purpose Financial Insurance Company, please contact us directly to obtain additional information.

Our current application forms are as below. For all other applications or questions please contact DFR Captive Insurance.


Forms and Templates

Our current required forms and templates are as below. For questions please contact DFR Captive Insurance.

All forms may be submitted electronically in combined single PDF unsecure format and Zip files are NOT accepted. Please see specific form and applications general instructions for further instructions and submission address.


Vermont Captive Annual Report (VCAR) Form Templates to be used by non-NAIC filers beginning with 2023 year-end filings, including subsequent fiscal year-ends, until superseded.

  • 2023 Guidance for all VCAR Forms - Important please read.
  • 2023 Instructions for all VCAR Forms - For reference.
  • VCAR Form - To be used by all Vermont licensed captives that are non-NAIC filers.  Excel file name = "VCAR Form - Version 2023"
  • VCAR Supplemental Form - To be used for unincorporated protected cells, separate accounts, and filings for insurance subsidiaries, unless required to file on NAIC forms.  Excel file name = "VCAR Supplemental Form - Version 2023".
  • VCAR Incorporated Protected Cell (IPC) Form - To be used for required separate reporting by the incorporated protected cells (IPC) of Vermont licensed sponsored captives, unless required to file on NAIC forms.  Excel file name = "VCAR Incorporated Protected Cell Form - Version 2023".
  • VCAR - Premiums (Page 5 only) - To be used by all fiscal year-end captives to report premium at 12/31 corresponding to Vermont Premium Tax filing.  DFR requires a copy of the final tax return and page 5 be filed with dfr.captivefinancialfilings@vermont.gov.  Note:  Page 5 should not be uploaded to MyVTax when the premium tax filing is made and payment remitted.    

Lists

Please note that the lists are updated as indicated below.  For questions or specific requests please contact DFR Captive Insurance

Actuarial Review Firms for Captive Exams and Applications - FY 7/1/22-6/30/2024

Approved Actuaries - updated monthly

Approved CPAs - updated monthly

Approved Management Companies - updated as changes occur

AUTHORIZED REINSURERS as of 12/31/2023 (NEW updated January 2024)- Captive Approved, Accredited, Certified and Licensed- as updated each calendar year-end.  

Vermont Captive Listing - as of 12/31/2023 (updated quarterly)

Vermont Captive License Summary - as of 12/31/2023 (updated quarterly)

2022 Vermont Captive Aggregate Report - (updated annually)

List of Examination Fee Staff Rates - Effective 07/01/2023

 Required Documents for all licensed captive insurance companies and risk retention groups by type: