Captive Insurance

Applications, Forms and Lists

Image result for vermont captive insuranceCAPTIVE INSURANCE

TEMPORARY NOTICE DURING WORK FROM HOME RESTRICTIONS:  Notarization on applications, biographical affidavits, forms and other filings
  • Documents requiring a notarized signature will be accepted without a notary, however we appreciate all best efforts to obtain notarization with the option of e-notarization, and electronic signatures are acceptable.


Captive Insurance NAIC Annual Statement FAQs

  1. What do I do if our Company had an audit adjustment last year?

Option 1: The NAIC Annual Statement Instructions state that corrections of errors in previously filed information should be reported as an adjustment to surplus in the current year with an appropriate identifying title as a write-in item for the Aggregate Write-ins for Gains or Losses to Surplus.

Approved Service Providers


Approved Service Providers

Approved Service Providers consist of approved independent CPAs, approved actuaries and approved captive management companies. The attached pdfs provide current listings in all of these categories. 


Where to Send
Notice & Registration Filings and General Information

Submit electronically to:

or Mail to:

Vermont Department of Financial Regulation - Captive Insurance Division
Val Stark, Captive Administrative Assistant
89 Main Street
Montpelier, VT  05620-3101
Tel:  802-828-3304


Subscribe to RSS - Captive Insurance

Contact Information

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

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

Twitter icon
Facebook icon
LinkedIn icon

Employee Information