Forms

Captive Insurer Forms

Captive Insurance Company Application - 440-4937: fillable form or pdf
Captive Insurer Reinsurance Exhibit - 440 4938: fillable form or pdf
Permit to Organize Captive Insurer With or Without Capital Stock - 440-4939: fillable form or pdf
Application for Authorization as Producer for Captive Insurers - 440-4940: fillable form or pdf
Designation of Registered Office and Registered Agent in Oregon - 440-4941: fillable form or pdf
Oregon Approved Irrevocable Letter of Credit - 440-4942: fillable form or pdf
Bank Deposit Confirmation - 440-4944: fillable form or pdf
Captive Insurance Company Feasibility Study - 440-4947: fillable form or pdf
Captive Insurance Annual Statement- 440-4948: fillable form or pdf

Provider Forms

Placement on Approved Captive Insurer Management Firm List - 440-4936: fillable form or pdf
Application to Certify Loss and Expense Reserves for Captive Insurers - 440-4945: fillable form or pdf
Authorization as an Independent Certified Public Accountant for Captive - 440-4946: fillable form or pdf