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.