Forms

PURPOSE: This rule sets out the forms which may be used in the regulation of captive insurance companies in this chapter. (1) The following forms are suggested, not mandatory, for filing with the department: (A) Captive Application for Admission (Form CI-1), revised on October 1, 2007, or any form which substantially comports with the specified form; (B) Captive Irrevocable Letter of Credit (Form CI-2), revised on October 1, 2007, or any form which substantially comports with the specified form; (C) Captive Application for Authorization as an Independent Certified Public Accountant (CPA) (Form CI-3) revised on October 1, 2007, or any form which substantially comports with the specified form; (D) Captive Application for Authorization to Certify Reserves (Form CI-4), revised on October 1, 2007, or any form which substantially comports with the specified form; and (E) Missouri Captive Insurance Premium Tax Return (Form CI-5), revised on October 1, 2007, or any form which substantially comports with the specified form. (2) Availability of Forms. The forms are available at the department’s office in Jefferson City, Missouri, on the department website, www.insurance.mo.gov, or by mailing a written request to the Missouri Department of Commerce and Insurance, PO Box 690, Jefferson City, Missouri 65102. AUTHORITY: section 374.045, RSMo 2000 and sections 379.1328 and 379.1421, RSMo Supp. 2007.* Original rule filed Nov. 15, 2007, effective June 30, 2008. Non-substantive change filed Sept. 11, 2019, published Oct. 31, 2019. *Original authority: 374.045, RSMo 1967, amended 1993, 1995; 379.1328, RSMo 2007; and 379.1421, RSMo 2007.