OAR 836-029-0120: Authorized Forms

(1) The following forms must be used for any applicant applying for a certificate of authority as a new captive insurer: (a) "Application for Permit to Organize Captive Insurer With or Without Capital Stock;” (b) “Application to Form a Captive insurer;" (c) "Biographical Affidavit for Captive insurer;" (d) "Oregon Division of Financial Regulation Captive Insurer Reinsurance Exhibit;" (e) "Oregon Approved Irrevocable Letter of Credit" if applicable; (f) "Statement of Economic Benefit to the State of Oregon;" and (g) "Appointment of a Registered Resident Agent as Attorney to Accept Service of Process." (2) Except for a captive insurance producer applying to be licensed as a producer pursuant to ORS 744.052 to 744.089, the following forms must be used when applying to become an approved captive insurer service provider: (a) "Application for Placement on Approved Captive Insurer Management Firm List;" (b) "Application to Certify Loss and Expense for Captive insurers Captive Actuary Application;" (c) "Application for Authorization as an Independent Certified Public Accountant for Captive insurers;" and (d) “Application for Authorization as Producer for Captive insurers.” (3) All captive insurers must use the "Captive Insurer Annual Statement Form." (4) The forms required in sections (1) to (3) of this section are set forth on the Division of Financial Regulation website of the Department of Consumer and Business Services at dfr.oregon.gov.