Get Forms Vermont Captive Admission

Completing the Forms Vermont Captive Admission is essential for organizations looking to establish a captive insurance entity in Vermont. This guide will provide step-by-step instructions to help you fill out the necessary fields accurately and efficiently.

Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the name of the proposed captive in the designated field.
3. Specify the parent or sponsor information, ensuring you provide the correct entity name.
4. Fill out the contact information for the individual overseeing the application, including their address and phone number.
5. Indicate the type of proposed captive by selecting from the provided options: Association, Pure, Industrial Insured, Risk Retention, or Sponsored.
6. Choose the organization form, selecting either Stock, Mutual, or Reciprocal.
7. Provide the principal place of business for the proposed captive.
8. List the resident registered agent and their address.
9. Identify the location of books and records pertinent to the proposed captive.
10. State the initial capital and surplus of the company. Ensure that the total amount is clearly indicated.
11. List the names and addresses of beneficial owners, indicating each person's percentage of ownership.
12. Explain the relationship among the beneficial owners of the proposed captive.
13. If letters of credit are to be used, provide the name and address of the bank involved.
14. Input the name of the management firm and their address.
15. Include the name and address of the lawyer representing the captive.
16. Fill out the claims handler information.
17. Provide the name and address of the certified public accountant.
18. Include the name and address of the actuary.
19. List the name of the (re)insurance broker, along with their address, the amount issued in favor of, and relevant details.
20. Supply biographical information for directors and officers, including their positions and employer details.
21. If applying as an industrial insured captive, complete the additional fields regarding employees and premiums.
22. Attach all required documents, including the feasibility study, certified copies of incorporation documents, and any additional information as outlined.
23. Review all provided information for accuracy and completeness before proceeding.
24. Submit the completed application and ensure you save a copy for your records.

Complete your Forms Vermont Captive Admission online today for a streamlined application process.