Section 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.Utah Admin. Code R590-238-19
Amended by Utah State Bulletin Number 2015-20, effective 9/25/2015Adopted by Utah State Bulletin Number 2024-01, effective 12/22/2023Amended by Utah State Bulletin Number 2024-18, effective 9/10/2024