The Ohio Department of Insurance Captive Insurance Company License Application, Form INS7020 (Rev. 02/2021), is the official five-page form that any business wanting to form and run an Ohio-domiciled captive insurer must complete and file with the Office of Captive Insurance. A captive is an insurance company you own to insure the risks of your own business or your affiliated companies, and Ohio will not let it operate until the Superintendent signs off on this application.
Getting one box wrong, like the type of captive or a missing biographical affidavit, can stall your file for weeks or trigger a request for more information that pushes back your start date. Ohio’s captive program is small but growing, and the state charges a flat $500 application fee with a minimum annual premium tax of $7,500, so accuracy here protects both your timeline and your wallet.
Here is what this guide gives you:
- 📋 A plain-English walkthrough of every field and box on Form INS7020
- 🧩 Three full filled-out examples for the most common captive types
- 🏛️ The exact statutes and rules that control how you answer each line
- 💵 Every fee, deadline, capital floor, and filing channel you must hit
- ⚠️ The field-level mistakes that get applications kicked back, and how to dodge them
What the Form Is and Who Must File It
Form INS7020 is the single license application that lets you form and operate a captive insurance company in Ohio. The form exists because Section 3964.03 of the Revised Code says no captive may “do the business of captive insurance” in the state without a license from the Superintendent of Insurance. The form collects who you are, what risks you want to insure, who will manage the captive, and proof that you can pay claims.
The agency that receives the form is the Ohio Department of Insurance, Office of Captive Insurance, in Columbus. The rule that fleshes out the form’s content is Ohio Administrative Code 3901-11-01, last updated in November 2024, which lists the attachments you must add to the form. The statute and the rule work together: the statute requires the license, and the rule tells you the exact papers to file to get it.
You must file this form if you want to own a “pure” captive that insures only your own group’s risks, a “protected cell” captive that rents cells to others, or a “special purpose financial” captive used in life reinsurance deals. The penalty for skipping the license is steep, because operating an unlicensed insurer in Ohio exposes you to enforcement action under Chapter 119 of the Revised Code, including license denial and orders to stop doing business. In short, no approved INS7020 means no legal captive.
Most filers do not complete this form alone. Ohio law and the Department’s guidance expect you to hire a captive manager, an actuary, and a CPA, and to talk with the Chief of Captive Insurance before you file. Think of yourself, the business owner or CFO, as the driver, and the captive manager as the navigator who prepares the binder.
Before You Start: Documents and Information You Need
Open the form only after you have gathered everything below. The application asks for facts and attachments at the same time, and a missing item is the top reason files sit in limbo. Ohio Administrative Code 3901-11-01 lists the required attachments, and the form’s own checklist on page 3 repeats them.
- Certified articles of incorporation, bylaws, and code of regulations from the Ohio Secretary of State, because the captive must legally exist before it can be licensed, and a draft copy is not accepted.
- Your Federal Employer ID Number (FEIN), since the Department keys your file to this number and an IRS mismatch can delay correspondence.
- A sworn statement of financial condition signed by the President and Secretary, because the Superintendent must see you can pay claims, and an unsigned statement is treated as missing.
- A plan of operation plus a one-to-two-page executive summary, since these explain how the captive will run, and a vague plan draws follow-up questions that add weeks.
- A board-adopted investment policy, because Ohio reviews how you will hold reserves, and without it the file is incomplete.
- Biographical affidavits on Form INS7022 for every officer, director, and the captive manager, since the state vets the people in charge, and one missing affidavit holds the whole file.
- Third-party background verifications from an NAIC UCAA approved vendor, mailed straight from the vendor to the Department, because self-submitted verifications are rejected.
- Most recent audited financial statements of the captive’s sponsor or parent, since the Department tests the parent’s ability to fund the captive.
- Actuarial assumptions and methodologies for reserves, because reserves must be actuarially sound, and guesswork rates get bounced.
- A $500 check payable to “Treasurer – State of Ohio,” since the application fee must precede or accompany the filing, and an unpaid file is not reviewed.
Confirm your minimum capital too. Ohio requires at least $250,000 in unimpaired paid-in capital and surplus for a typical captive, and the Superintendent can set a higher amount based on your risk under Section 3964.07.
Where to Get the Form and How to Access It
You download Form INS7020 directly from the Ohio Department of Insurance website. The official PDF lives on the Department’s captive forms page, and it is a fillable five-page document marked “INS7020 (Rev. 02/2021).” Always check that revision date in the footer before you start, because filing an outdated version forces a re-do.
You have two ways to submit. The first is the online Gateway portal, where you create an account and upload the form and every attachment as files. The second is hard copy, where you place the signed form and all attachments in a three-ring binder, indexed and tabbed in the exact order page 3 lists, and mail it to the Office of Captive Insurance.
Before you touch the form, the Department asks you to call the Chief of Captive Insurance to discuss your plan. This informal pre-filing talk is a feature, not a hurdle, because it lets the regulator flag problems early and saves you from a surprise rejection. The contact number sits on the Department’s “How to Form a Captive” page.
The form itself is short, but the attachments are the heavy part. Treat the PDF as a cover sheet for a much larger package. Most applicants let their captive manager assemble the binder while the owner reviews and signs the certification on page 3.
Step-by-Step: How to Fill Out Form INS7020 Line by Line
The form runs five pages. Pages 1 and 2 collect demographic and contact facts, page 2 also lists the 14 numbered attachments, page 3 holds the attachment checklist and your signature, page 4 is a special workers’ compensation authorization, and page 5 is the payment voucher. Fill each field below in the order it appears.
Field 1: Name of Entity Seeking Captive License
This box asks for the exact legal name of the captive company you formed with the Secretary of State. Write the name precisely as it appears on your articles of incorporation, including “Inc.,” “LLC,” or “Corp.” For example, Buckeye Manufacturing Captive, Inc. goes here, not a shortened nickname.
The most common edge case is a name reservation that has not yet become a final filing. If your entity is not officially formed, you cannot complete this box, because the Department needs a real, registered company. A common mistake is entering the parent company’s name instead of the captive’s name, which confuses the Department about who is being licensed and delays matching the file to your articles. Many filers wrongly believe the captive can share its parent’s exact name; it cannot, since each entity must be distinct on the state register.
Field 2: Federal Employer ID (FEIN)
This field asks for the captive’s nine-digit IRS tax number. Enter it in the standard XX-XXXXXXX format with the dash. For example, 34-1234567 is how a Cincinnati captive would write it.
The edge case here is a brand-new captive that has not yet received its FEIN from the IRS. You must obtain the FEIN before filing, because the Department uses it to track your company. A common mistake is entering the parent’s FEIN, which links your file to the wrong taxpayer and can cause premium-tax billing errors later. People often think any tax ID works; it does not, since the number must belong to the captive entity itself.
Field 3: Date of Incorporation or Formation
This box asks when your captive was legally created. Use MM/DD/YYYY format and match the date stamped on your Secretary of State filing. For example, 03/14/2026 would be the formation date for a captive organized that day.
If your entity is an LLC rather than a corporation, the form still wants the formation date, so enter the date your articles of organization were accepted. A common mistake is guessing the date or using the date you signed internal documents, which will not match the certified articles you attach and triggers a mismatch flag. Some filers assume the application date and formation date can be the same; they usually are not, since the entity must exist before you apply.
Field 4: Parent or Sponsor
This field asks who owns or backs the captive. Enter the full legal name of the parent company or sponsor that controls the captive. For example, Buckeye Manufacturing Holdings, LLC would appear here as the parent of the captive in Field 1.
The term “parent” has a legal meaning under Chapter 3964: an entity that owns or controls more than fifty percent of the captive. A common mistake is naming a sister company or a minority investor instead of the true controlling parent, which misstates the corporate structure the Department must verify. Filers sometimes think “sponsor” and “parent” are interchangeable for every captive type; for a protected cell captive the sponsor organizes the cells, so use the correct term for your structure.
Fields 5–12: Address, Phone, and Email of the Entity
These boxes ask for the captive’s physical street address, city, state, ZIP, phone, and email. Enter a real street address, not a P.O. Box, in the street field, then add city, state, and ZIP in the matching lines. For example, 50 Riverside Plaza, Columbus, OH 43215 with a working phone and a monitored email.
The edge case is a captive whose only “office” is its captive manager’s location, which is allowed as long as it is a genuine Ohio business address. A common mistake is listing an out-of-state corporate headquarters here, which conflicts with Ohio’s requirement that the captive maintain an Ohio place of business and draws a correction notice. Many filers think a mailing P.O. Box is fine for the physical field; it is not, since service and examination need a street location.
Field 13: Type of Proposed Captive
This is one of the most important boxes, and it asks you to check Pure, Protected Cell, or Special Purpose Financial. Check the single box that matches your structure: Pure if you insure only your own group, Protected Cell if you offer cells to participants, or Special Purpose Financial for life-reinsurance vehicles. For example, a single manufacturer self-insuring its own property would check Pure.
The edge case is a captive that may add cells later; you still check the type you are licensing for now, not a future plan. A common and costly mistake is checking Protected Cell when you mean a pure captive, because protected cell captives carry an extra $50-per-cell annual fee and different reporting, so the wrong box changes your obligations. Filers often believe they can switch types informally after licensing; any change must be filed with the Superintendent under the change rules in OAC 3901-11-01.
Field 14: Organization Form
This field asks how the captive is legally organized, and you check Corporation, Nonprofit, or LLC. Pick the box that matches your Secretary of State articles. For example, a captive formed under Chapter 1706 of the Revised Code would check LLC.
The edge case is a series LLC or unusual structure; if it does not fit neatly, discuss it with the Chief of Captive Insurance before filing. A common mistake is checking Corporation when the articles say LLC, which contradicts your attached formation documents and forces a fix. Some filers think the organization form is just a formality; it is not, because it controls which governance and tax rules apply to your captive.
Field for Lines of Business Under 3964.02
This section lists nine specific lines, such as Commercial Multiple Peril, Ocean Marine, Inland Marine, Medical Malpractice, Workers’ Compensation, Commercial Auto Liability and Physical Damage, Fidelity, and reinsurance of certain life risks. Check every line your captive intends to write. For example, Buckeye Manufacturing Captive, Inc. might check Commercial Multiple Peril and Commercial Auto Liability for its plant and fleet.
A key edge case is workers’ compensation, which under division (A)(5) of Section 3964.02 is allowed only to indemnify a self-insuring employer, so check it only if that fits you. A common mistake is checking lines you “might” use someday, which inflates your plan of operation and invites questions about reserves you cannot support. Filers often assume a captive can write any commercial coverage; it cannot, since only the listed lines are pre-approved and anything else needs separate sign-off.
Field for Other Lines of Business (A)(10)
This box covers any line not listed above, and it warns that you need prior written approval from the Superintendent under division (A)(10) of Section 3964.02. Check it and attach a request only if your coverage falls outside the nine standard lines. For example, an unusual contingency coverage would require this approval before you can write it.
The edge case is a captive that plans a novel product; you must describe it and wait for written approval, because the Department will not assume it is permitted. A common mistake is writing an unapproved line first and seeking approval later, which is an unauthorized act that can jeopardize your license. People often think captives have broad freedom to insure anything; in Ohio, anything off the list is closed until approved.
Field 15: Principal Place of Business in Ohio
This field asks for the captive’s main Ohio mailing and business location, with a contact name, street address, city, OH, ZIP, phone, and email. Enter a genuine Ohio address, often your captive manager’s office, with a named contact who can receive Department mail. For example, contact Dana Reed at 50 Riverside Plaza, Columbus, OH 43215.
The edge case is a captive managed from another state; even then, Ohio expects an Ohio business presence, so coordinate with your captive manager. A common mistake is leaving the contact name blank, which leaves the Department with no one to reach and stalls follow-up. Filers sometimes think the parent’s headquarters can serve as this address; it cannot if the parent sits outside Ohio.
Field 16: Location of Books and Records
This box asks where the captive’s books and records are kept, if different from Field 15. Fill in the contact, street address, city, state, ZIP, and phone only if records live somewhere other than the principal office. For example, if records sit with the CPA in Cleveland, enter that office here.
The edge case is electronic records hosted by a third-party administrator; list the responsible custodian’s address. A common mistake is leaving this blank when records are truly elsewhere, which can complicate the Department’s examination rights. Some filers think records can be stored anywhere quietly; the Department must always know where to find them for audits.
Field 17: Agent for Service of Process
This field asks for the full name and Ohio address of the agent registered with the Ohio Secretary of State to receive legal papers. Enter the agent’s contact name, street address, city, OH, ZIP, phone, and email, matching the agent on file with the state. For example, Statutory Agent Services, 50 W. Broad St., Columbus, OH 43215.
The edge case is using a commercial registered-agent firm, which is fine as long as it is registered for your captive. A common mistake is naming an agent who is not actually registered with the Secretary of State, which means legal notices may never reach you and exposes the captive to default. Filers often assume the captive manager is automatically the agent; that is true only if formally appointed and registered.
Field 18: Name of Captive Manager
This box asks for the captive manager who will run day-to-day operations, with contact name, Ohio address, phone, and email. Enter the manager’s firm and a named individual, since Ohio Administrative Code 3901-11-01 requires the manager’s Ohio residential or business address. For example, Midwest Captive Management, attn. Dana Reed, Columbus, OH.
The edge case is a self-managed captive; even then, the Department strongly prefers a qualified manager, so discuss any exception in advance. A common mistake is naming a manager with no Ohio address, which conflicts with the rule and triggers a deficiency. People often think a captive can run with no manager at all; in practice, Ohio expects professional management and reviews the manager’s qualifications.
Field 19: Name of Certified Public Accountant
This field asks for the independent CPA who will audit the captive, with contact, address, phone, and email. Enter the audit firm and a partner contact, because Section 3964.07 requires an annual independent audit. For example, Keystone CPAs LLP, attn. Sam Ortiz.
The edge case is a CPA who must be approved by the Department; under OAC 3901-11-03 you report any change of auditor within thirty days. A common mistake is naming a non-independent in-house accountant, which fails the independence requirement and voids the audit. Filers sometimes think the parent’s auditor can serve without review; the Department still expects independence for the captive.
Field 20: Name of Actuary
This box asks for the qualified actuary who will support your reserves and rates, with contact details. Enter the actuary’s firm and named individual, since actuarial soundness is mandatory for direct coverage to a parent under OAC 3901-11-01. For example, Buckeye Actuarial Group, attn. Priya Nair.
The edge case is a captive writing only reinsurance, which still needs actuarial support for its reserve methodology. A common mistake is leaving this blank or naming an unqualified person, which undermines the actuarial opinion the Department relies on. People often believe small captives can skip the actuary; they cannot, because reserves must be defensible.
Field 21: Capital and/or Surplus of Company
This field asks for your Initial Capital, Initial Surplus, and Total in dollars. Enter the funded amounts, making sure the total meets or beats Ohio’s $250,000 minimum unless the Superintendent set a higher figure for your risk. For example, Initial Capital $150,000, Initial Surplus $150,000, Total $300,000.
The edge case is funding with approved letters of credit or marketable securities rather than cash, which Ohio allows within limits. A common mistake is listing the minimum when your risk profile demands more, which leads the Superintendent to raise the requirement under Section 3964.07 and delays approval. Filers often think $250,000 is always enough; the Department can require more based on premium volume and the lines you write.
Fields 22–23: Certification and Signature (Page 3)
This block asks an authorized director, officer, or member to certify that everything in the application is true. Sign and date the original, then print or type your name in the signature line. For example, Marcus Hill, Director signs and dates 03/14/2026.
The edge case is a captive with only members and no officers; an LLC member may sign. A common mistake is having an unauthorized person sign, such as an outside consultant, which invalidates the certification. People often think a digital placeholder is enough; an original signature is required, since you are attesting under penalty for false statements.
Page 4: Workers’ Compensation Authorization
This page applies only if you checked workers’ compensation in the lines of business. It authorizes the Ohio Bureau of Workers’ Compensation to share your self-insuring status with the Department, and asks for the employer name, EIN, signature, date, and title. For example, Buckeye Manufacturing Holdings, LLC, EIN 34-7654321, signed by its CFO.
The edge case is a captive that does not write workers’ comp; you simply leave this page blank. A common mistake is signing this page when you do not write workers’ comp, which adds confusion, or skipping it when you do, which blocks the data-sharing the Department needs. Filers often think any captive can freely write workers’ comp; it is limited to self-insuring employers under division (B)(1) of Section 4123.82.
Page 5: Payment Voucher and Attachment Checklist
Page 5 is the payment voucher, and page 3 lists the 14 numbered attachments. Complete the voucher with the captive’s name and address, the captive manager or contact, and the amount paid, then make sure every checklist item from the certified articles through the $500 fee is in your binder or upload. For example, the voucher shows Amount Paid $500 with a check to Treasurer – State of Ohio.
The edge case is paying for extra protected cells, which adds $50 per cell at annual fee time. A common mistake is sending payment without the voucher, which the Department warns may be returned, delaying your file. People often think the application fee is refundable if denied; treat it as a non-refundable filing cost.
Three Filled-Out Examples Using Real Scenarios
Below are three named filers showing how the most common captive types complete Form INS7020. Each table walks the major fields from name through capital.
Scenario 1: Marcus Hill forms a Pure captive for his manufacturing group.
| Form Section | What Marcus Enters |
|---|---|
| Name of Entity (Field 1) | Buckeye Manufacturing Captive, Inc. |
| FEIN (Field 2) | 34-1234567 |
| Date of Formation (Field 3) | 03/14/2026 |
| Parent or Sponsor (Field 4) | Buckeye Manufacturing Holdings, LLC |
| Type of Captive (Field 13) | Pure |
| Organization Form (Field 14) | Corporation |
| Lines of Business | Commercial Multiple Peril; Commercial Auto Liability |
| Captive Manager (Field 18) | Midwest Captive Management, Columbus, OH |
| Capital and Surplus (Field 21) | Total $300,000 |
Scenario 2: Dana Reed forms a Protected Cell captive renting cells to small businesses.
| Form Section | What Dana Enters |
|---|---|
| Name of Entity (Field 1) | Riverside Protected Cell Captive, LLC |
| FEIN (Field 2) | 31-7654321 |
| Date of Formation (Field 3) | 04/02/2026 |
| Parent or Sponsor (Field 4) | Riverside Risk Sponsor, LLC |
| Type of Captive (Field 13) | Protected Cell |
| Organization Form (Field 14) | LLC |
| Lines of Business | Commercial Multiple Peril; Fidelity |
| Captive Manager (Field 18) | Riverside Captive Services, Columbus, OH |
| Capital and Surplus (Field 21) | Total $500,000 (plus $50 per cell at renewal) |
Scenario 3: Priya Nair forms a reinsurance captive for affiliated company risks.
| Form Section | What Priya Enters |
|---|---|
| Name of Entity (Field 1) | Keystone Re Captive, Inc. |
| FEIN (Field 2) | 35-2468013 |
| Date of Formation (Field 3) | 02/20/2026 |
| Parent or Sponsor (Field 4) | Keystone Industries, Inc. |
| Type of Captive (Field 13) | Pure |
| Lines of Business | (D) Reinsurance of risks insured by parent or affiliate |
| Reinsurance Attachment (#17) | Plan of reinsurance, direct insurer details, risk transfer analysis |
| Captive Manager (Field 18) | Keystone Captive Management, Columbus, OH |
| Capital and Surplus (Field 21) | Total $400,000 |
Each filer attaches the full binder, signs page 3, and pays the $500 fee with the voucher on page 5.
How to File the Completed Form
Ohio gives you two filing channels, and both end at the Office of Captive Insurance in Columbus. Choose the one your captive manager prefers, but keep proof of whatever you send.
The online channel uses the Gateway portal. You create an account, then upload the signed Form INS7020 and every attachment as digital files. There is no portal “fee” beyond the $500 application fee, which you still pay by check with the voucher, and you should save the upload confirmation as your proof of filing. Expect the Department’s review to run on a roughly thirty-day cycle for many supplemental filings, though a full initial license review can take longer depending on complexity.
The hard-copy channel uses a three-ring binder. You index and tab the binder in the exact order page 3 lists, from the certified articles through the application fee, and mail it to the Ohio Department of Insurance, Office of Captive Insurance, 50 W. Town St., 3rd Fl, Suite 300, Columbus, Ohio 43215-4186. Send the $500 check payable to “Treasurer – State of Ohio” with the page 5 voucher, and use a trackable mail service so you keep a delivery receipt as proof.
Accepted payment is by check; the Department warns that payments received without the voucher may be returned, which delays everything. Keep a full copy of your binder or upload, your check number, and your tracking or confirmation number. These records are your evidence that you filed on time and in full.
What Happens After You File
After you file, the Office of Captive Insurance reviews your form and every attachment for completeness and soundness. If something is missing, like a biographical affidavit or the third-party verification, the Department sends a deficiency notice, and the clock effectively pauses until you cure it. This is why a complete first submission is the fastest path.
The Superintendent then evaluates your plan of operation, capital, and the background of your officers, directors, and manager. Examination costs fall on you under the form’s terms, since the Superintendent may retain outside legal, financial, and examination services at the applicant’s expense. Many supplemental filings are deemed approved thirty days after receipt unless the Superintendent disapproves them in that window, per OAC 3901-11-01.
Once approved, you fund the minimum capital and surplus and receive your license to do captive business. From there you owe ongoing duties: an annual statement by March 1, an audited financial report by June 1 under Section 3964.07, and the $500 annual renewal fee plus a minimum $7,500 premium tax. Any change to the facts you reported must be filed within thirty days.
Mistakes to Avoid When Filling Out the Form
- Entering the parent’s name in Field 1 instead of the captive’s name, which keeps the Department from matching your file to your articles.
- Using the parent’s FEIN in Field 2, which links your application to the wrong taxpayer and causes billing errors.
- Checking Protected Cell when you mean Pure, which saddles you with the $50-per-cell fee and extra reporting you did not intend.
- Checking lines of business you “might” write someday, which forces you to justify reserves you cannot support.
- Writing a non-listed line without (A)(10) approval, which is an unauthorized act that can jeopardize the license.
- Listing an out-of-state address as the Ohio principal place of business, which violates the Ohio-presence requirement.
- Naming an agent for service of process who is not registered with the Secretary of State, which means legal notices may never reach you.
- Naming a captive manager with no Ohio address, which contradicts OAC 3901-11-01 and triggers a deficiency.
- Funding only $250,000 when your risk demands more, which leads the Superintendent to raise your capital requirement.
- Self-submitting biographical verifications instead of having the NAIC-approved vendor mail them directly, which gets them rejected.
- Sending the $500 check without the page 5 voucher, which the Department warns may be returned and delays review.
- Signing page 4 workers’ comp authorization when you do not write workers’ comp, or skipping it when you do.
Do’s and Don’ts
Do:
- Call the Chief of Captive Insurance before filing, because early feedback prevents costly rework.
- Match every field to your certified Secretary of State documents, since mismatches trigger deficiency notices.
- Hire a qualified captive manager, CPA, and actuary, because Ohio expects professional support for the file.
- Use a street address, not a P.O. Box, for physical-address fields, since service and examination need a real location.
- Keep proof of filing and your check number, because you may need to show you filed in full and on time.
- Re-read the page 3 checklist before sending, since one missing tab can pause the whole review.
Don’t:
- Don’t file before your entity is formed, because the Department needs a real, registered captive.
- Don’t check captive types or lines you do not actually need, since each adds cost or scrutiny.
- Don’t let a non-independent accountant serve as your CPA, because the audit must be independent.
- Don’t assume $250,000 is automatically enough, since the Superintendent can require more.
- Don’t mail payment without the voucher, because it may be returned.
- Don’t ignore the thirty-day change-reporting rule after licensing, since stale information can draw enforcement.
Pros and Cons of Filing on Your Own vs. With a Captive Manager
| Filing With a Captive Manager | Filing Largely on Your Own |
|---|---|
| Pro: Manager knows the binder order and avoids deficiency notices, saving weeks. | Pro: You save the manager’s fees, which helps a very small captive’s budget. |
| Pro: Provides the required Ohio business address and contact the Department expects. | Pro: You keep direct control over every entry and timeline. |
| Pro: Coordinates the actuary, CPA, and biographical verifications for you. | Pro: You learn the program deeply for future filings. |
| Pro: Speaks the regulator’s language during the pre-filing call. | Con: Higher risk of a wrong box, like captive type, that resets your review. |
| Pro: Reduces the chance of an unauthorized-line or capital error. | Con: Ohio still expects professional management, so going fully solo is rarely accepted. |
| Con: Adds management cost to your annual budget. | Con: Missing the Ohio-address or independence rules can stall or sink the file. |
FAQs
Do I check Pure or Protected Cell if I only insure my own company?
Yes, check Pure. A pure captive insures only the risks of its parent and affiliates, while Protected Cell is for sponsors offering cells to other participants.
Do I write the parent’s name in Field 1?
No, Field 1 is for the captive’s own legal name exactly as registered. The parent’s name goes in Field 4 as the parent or sponsor.
Do I need an Ohio address for the captive manager in Field 18?
Yes, OAC 3901-11-01 requires the captive manager’s Ohio address. A manager with no Ohio location triggers a deficiency notice.
Do I use a P.O. Box in the physical address fields?
No, the form asks for a physical street address. A P.O. Box does not satisfy service-of-process and examination needs.
Do I need to fill out page 4 if I don’t write workers’ comp?
No, page 4 applies only to applicants writing workers’ compensation under division (A)(5) of Section 3964.02. Leave it blank otherwise.
Do I need a captive manager to file?
Yes, in practice. Ohio strongly expects a qualified captive manager, and the Department reviews the manager’s qualifications as part of the file.
Do I have to submit biographical affidavits for everyone?
Yes, every officer, director, and the captive manager needs an INS7022 affidavit, plus third-party verification mailed directly from an NAIC-approved vendor.
Do I pay the $500 fee online through the Gateway?
No, the application fee is paid by check to “Treasurer – State of Ohio” with the page 5 voucher, even when you upload the form.
Do I need at least $250,000 in capital?
Yes, that is the typical minimum unimpaired paid-in capital and surplus, though the Superintendent can require more based on your risk under Section 3964.07.
Do I get my application fee back if I’m denied?
No, treat the $500 application fee as a non-refundable filing cost regardless of the outcome.
Do I have to use the three-ring binder format?
No, only if you file hard copy. You may upload the form and attachments through the Gateway portal instead.
Do I need approval to write a line of business not listed on the form?
Yes, any line outside the listed nine needs prior written approval from the Superintendent under division (A)(10) of Section 3964.02.
Do I report changes after I’m licensed?
Yes, any change to the information you filed must be reported to the Superintendent within thirty days under OAC 3901-11-01.
Do I need a separate FEIN for the captive?
Yes, the captive needs its own FEIN. Using the parent’s number links your file to the wrong taxpayer and causes billing errors.
Related reading
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- How to Fill Out the Massachusetts Captive Insurance Company Application + FAQs
- How to Fill Out the Agency Captive Application (w/Examples) + FAQs
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