Statement from Commissioner Pieciak: DFR staff continue to work remotely and will do so until further notice. The department is still conducting business, however there may be some temporary delays in DFR services. 

Forms and Templates

CAPTIVE INSURANCE

(NEW)Business Plan Change Form for Addition of Protected Cells - including general instructions and guidance

Actuary Application - to become approved for Vermont Captives

CPA Application - to become approved for Vermont Captives

Biographical Affidavit - including general instructions

Please note that the "Abbreviated Biographical Affidavit" is to be used to submit significant changes to Biographical Affidavit Forms already on file.  The form is available upon request to DFR Captive Insurance as required.

(NEW)Audit and SAO Submital Form - New mandatory fillable PDF for all captive filers                                                (General Instructions for reference only)

Biographical Affidavit - Vermont Resident Directors ONLY - including general instructions

CPA Certification of Review of Audit Work Papers- required for all audit filings

Letter of Credit- required content with 7 provisions

RRG Independence Certification- sample WORD template to be filed annually

Vermont Captive Annual Report (VCAR) General Instructions - IMPORTANT please read

 

 

 

Contact Information

Department of Financial Regulation
Consumer Services 
89 Main Street, Montpelier, VT 05620 - 3101

802-828-3301
833-DFR-HOTLINE (toll free)
833-337-4685 (toll free)

Public Information
For public records, media inquiries, and press releases visit our Public Information web page

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Employee Information