The New Jersey Captive Insurance Company Application is the form a business uses to ask the New Jersey Department of Banking and Insurance (DOBI) for a license to run its own insurance company under N.J.S.A. 17:47B-1 et seq. The form is reviewed by the Office of Captive Insurance, and a company cannot write a single dollar of coverage in the state until DOBI approves it.
A captive is an insurance company that a parent business owns to cover its own risks instead of buying from an outside carrier. New Jersey can move from first meeting to license in about 30 days when an application is clean, but a missing answer can stop the clock cold. The form even warns at the top that incomplete applications will be returned, so one blank box can cost weeks.
Here is what this guide gives you:
- 📋 A plain-English walkthrough of every numbered item on the official application, from the captive’s name to the final signature.
- 💰 The real costs, including the formation fee, the up-to-$4,000 outside actuary review, and the annual premium tax.
- 🧩 Three full filled-out examples for a pure captive, an association captive, and a sponsored captive.
- ⚠️ The exact lines filers get wrong and the direct consequence of each slip.
- 🗂️ A pre-filing checklist of every document you must gather before you open the form.
What the Form Is and Who Must File It
The Captive Insurance Company Application is the entry door to forming a licensed captive in New Jersey. It is required by N.J.S.A. 17:47B-2, which says no captive may write business in the state until it first obtains a license from the Commissioner. The form is part of the larger Admission Packet described in N.J.A.C. 11:28-1.3, and it feeds the agency the core facts it needs to judge your plan.
In plain terms, a captive lets a company self-insure in a structured, regulated way. A national retailer, a hospital network, or a group of contractors might form one to cover risks that are hard or costly to insure on the open market. The statute is firm about limits, though, so a pure captive may only insure the risks of its parent and affiliates, and no captive may sell private passenger auto or homeowner’s coverage.
Who files this form? The applicant is the proposed captive, but the actual drafting is almost always done by a licensed captive manager, an insurance attorney, or the parent company’s risk officer. These are sophisticated filers, not stressed individuals, yet even pros trip on this form because each box ties to a statute or a financial test. The plan must convince DOBI that the captive will “promote the general good of the State” under N.J.S.A. 17:47B-5, which is the standard the whole packet is built to meet.
The form does not stand alone. It rides alongside a business plan, biographical affidavits, an actuarial feasibility study, bylaws, and a letter of credit. Think of the application as the cover sheet that organizes a much thicker file. Get the cover sheet wrong and the reviewer never reaches the strong parts of your plan.
Before You Start: Documents and Information You Need
The form asks for facts that live in many places, so gather them first. The application itself tells you to answer every question and never leave a box blank, which means you need each item ready before you type. Missing pieces are the top reason packets bounce back from the Office of Captive Insurance.
Pull these together before you open the form:
- Proposed captive name, checked for conflicts, because N.J.S.A. 17:47B-2 bars a name that is deceptively similar to an existing one, and a clash forces a refile.
- Federal Employer Identification Number (FEIN), since the form asks for it in Item 3 and DOBI uses it to track the entity.
- Date and form of organization (stock, mutual, LLC, and the like), because Item 3 needs both and your bylaws must match.
- Audited financial statements of the beneficial owners, which Item 7 requires as an enclosure to prove the parent can fund the captive.
- Full ownership chart with percentages, to answer Items 4 through 6 without guesswork.
- Names of all officers and directors, for Item 9, since DOBI runs character and experience checks on each.
- Capital and surplus figures and their source, for Item 14, where the state expects at least $250,000 for a pure captive.
- Names and addresses of your service providers (captive manager, attorney, CPA, actuary, claims handler), for Items 20 through 25, because the law demands in-state expertise.
- A New Jersey resident registered agent, for Item 13, required by statute to accept service of process.
- Letter of credit details if you plan to use one, for Item 15, including the issuing bank and the amount.
If any item is missing, the consequence is concrete. The form is returned, your place in the review line is lost, and your target license date slips. Gathering everything up front is the single best way to keep the 30-day clock running in your favor.
Where to Get the Form and How to Access It
The application lives on the DOBI website, not in a paper office drawer. You download the Captive Insurance Company Application as a PDF from the Office of Captive Insurance forms page. The same page hosts the formation packet index with the related forms you will file alongside it.
The form carries the internal mark DHT11-03 Appendix A Exhibit 1 in its footer rather than a plain calendar revision date. Because DOBI does not stamp an obvious year on it, always re-download a fresh copy from the agency site right before you file so you know you have the current version. Filing an outdated form risks a return if the agency has quietly updated a field.
You complete the PDF, print it, and sign where indicated. The instructions then tell you to submit one signed original by mail and to email a PDF copy to dobi.captives@dobi.nj.gov. New Jersey strongly favors a pre-filing meeting first, so most filers contact the Office of Captive Insurance before sending anything, then submit the polished packet.
A smart move is to read the Office of Captive Insurance Reference Guide before you start typing. It lists the business-formation fees and walks through the full admission flow. Treating that guide as your map keeps you from filling out the form in the wrong order.
Step-by-Step: How to Fill Out the Captive Insurance Company Application Line by Line
Work through the form in order, top to bottom. At the very top, two checkboxes ask whether this is a Captive Formation or a Captive Redomestication. Check Captive Formation if you are building a brand-new captive in New Jersey, and check Captive Redomestication only if you are moving an existing captive from another state under N.J.A.C. 11:28-1.4. Choosing the wrong box routes your file down the wrong review track and delays everything.
Item 1 — Name of Proposed Captive
This box asks for the exact legal name your captive will carry. Write the full name as it will appear on your articles of incorporation, with the correct ending such as Inc., LLC, or Insurance Company. For example, Garden State Risk Insurance Company, Inc. is a clean, complete entry.
A nuance many filers miss is name clearance. New Jersey blocks any name that is the same as, or deceptively similar to, an existing registered business under N.J.S.A. 17:47B-2, so check availability before you commit. If you have a P.O. Box or a holding-company suffix question, resolve it now, not later.
The common mistake here is entering a “working title” that does not match the name on the bylaws and articles. When the names disagree, DOBI cannot tie the documents together and returns the packet. The misconception is that the name can be tweaked freely after filing; in reality, a name change after submission can force a fresh review of your formation documents.
Item 2 — Type of Proposed Captive
This item asks you to mark the kind of captive you are forming. The choices are Pure, Association, Industrial Insured, Branch, and Sponsored, and you check exactly one. A single-parent company covering only its own group checks Pure, while a trade group covering its members checks Association.
The type drives everything downstream, so match it to the limits in N.J.S.A. 17:47B-2. A Pure captive may insure only its parent, affiliates, and controlled unaffiliated business, while a Branch captive is the New Jersey arm of an alien captive. For example, Acme Manufacturing Captive checks Pure because it insures only Acme’s plants.
The frequent mistake is checking Pure while the business plan describes insuring outside members, which is a contradiction the actuary will flag at once. The consequence is a rejection on legal grounds, because the structure does not match the law for that type. The misconception is that the type is just a label; it actually sets your minimum capital, your allowed insureds, and your reporting path.
Item 3 — Form of Organization, Date of Formation, and FEIN
This item asks how the entity is legally built and when. Check one form among Stock, Mutual, Reciprocal, LLC, Non-profit, or Other, then enter the date of formation and the FEIN. For example, an LLC captive enters LLC, a formation date of 01/15/2026, and its nine-digit FEIN as 12-3456789.
A nuance is that the form of organization must match your filed articles and your bylaws word for word. If you choose Other, briefly name the structure so the reviewer is not left guessing. The date of formation should reflect when the entity was actually created with the state, not when you started planning.
The common mistake is leaving the FEIN blank because the entity is brand new, which stalls the file since DOBI uses that number to track you. Apply for the FEIN from the IRS first, then file. The misconception is that an LLC and a corporation are interchangeable here; they are not, because the form dictates whether you file articles of incorporation or LLC articles of organization.
Items 4, 5, and 6 — Parent, Beneficial Owners, and Their Relationships
These three linked items ask who owns and controls the captive. Item 4 wants the parent or beneficial owner and its percentage of ownership, Item 5 lists every beneficial owner, and Item 6 explains how those owners relate to each other. For example, Acme Holdings, Inc. is listed in Item 4 at 100%, with no others in Item 5.
A nuance shows up with layered ownership. If a holding company sits above the parent, disclose the chain so the percentages add to 100 percent and the relationships in Item 6 are clear. For a group captive, list each owner and state plainly that they are unaffiliated members of the same trade association.
The common mistake is hiding or rounding ownership so the numbers do not total 100 percent, which triggers a follow-up that delays approval. The consequence is a confidentiality and control concern, since DOBI must know exactly who stands behind the risk. The misconception is that minor owners can be skipped; the form wants the full picture, and Item 7 then requires the audited financials of those owners.
Item 7 — Audited Financial Statements of Beneficial Owners
This item is an enclosure rule, not a blank to type in. It tells you to attach the most recent audited financial statements of the beneficial owners. For example, Acme Holdings attaches its CPA-audited balance sheet and income statement for the latest fiscal year.
The nuance is that “audited” means a true independent audit, not internal or reviewed statements. If an owner is newly formed and has no audit yet, explain that in a cover note and provide the best available certified financials. DOBI uses these to test whether the owner can stand behind the captive’s promises.
The common mistake is attaching unaudited or stale statements, which forces the reviewer to ask for replacements and stalls the file. The consequence ties directly to N.J.S.A. 17:47B-2, which makes the owner’s financial strength a licensing factor. The misconception is that the captive’s own projections are enough; the state wants proof of the owner’s backing, not just the captive’s plan.
Item 8 — Application Contact Person
This item asks for the one person DOBI should call about the application. Enter the name, address, telephone number, and email of that contact. For example, Dana Reyes, Garden State Captive Managers, 100 Market St., Trenton, NJ 08608, 609-555-0140, dreyes@gscm.com.
The nuance is that this should be someone who actually knows the file, usually the captive manager or attorney, not a busy executive who will miss messages. A wrong or slow contact means the agency’s questions sit unanswered, and the review clock keeps ticking. List a direct email, since DOBI runs the process largely by email at dobi.captives@dobi.nj.gov.
The common mistake is naming a person who is hard to reach or who leaves the project mid-review. The consequence is missed deadlines on agency requests, which can stall or even sink the application. The misconception is that this contact must be an owner; it can be any authorized professional on the team.
Item 9 — Officers and Directors
This item asks for the leadership of the proposed captive by title. Fill in the Chairman, President, Vice President and Secretary, any Vice Presidents, Assistant Secretary, and Directors. For example, President: Lena Okafor; Vice President and Secretary: Marcus Bell; Directors: Lena Okafor, Marcus Bell, Priya Shah.
The nuance is that each named person will need a biographical affidavit under N.J.A.C. 11:28-1.3, so name only people ready to be vetted. DOBI weighs the “expertise, experience and character” of those who will manage the captive, so the slate should look credible. Match these names exactly to the affidavits you file.
The common mistake is listing placeholder names or leaving a title blank when no one fills it; instead, write not applicable rather than leaving an empty box. The consequence of a blank is a returned form, since the instructions forbid blanks. The misconception is that titles are cosmetic; in fact, the management team is a core licensing factor.
Item 10 — Principal Office of the Proposed Captive
This item asks where the captive’s main office sits. Enter the full New Jersey street address. For example, 100 Market Street, Suite 300, Trenton, NJ 08608.
The nuance is that N.J.S.A. 17:47B-2 requires the captive to keep its principal place of business in New Jersey, and N.J.A.C. 11:28-1.3 lets that be the New Jersey office of the captive’s manager. So many captives list their manager’s Trenton or Newark office here. An out-of-state address in this box contradicts the statute.
The common mistake is entering the parent company’s out-of-state headquarters, which signals the captive is not truly domiciled in New Jersey. The consequence is a direct conflict with the in-state presence rule and a likely rejection. The misconception is that a registered-agent address satisfies this; the principal office and the registered agent are separate requirements.
Item 11 — Location of Books and Records
This item asks where the captive’s books and records will be kept. Enter the full address of that location. For example, Garden State Captive Managers, 100 Market Street, Suite 300, Trenton, NJ 08608.
The nuance is that records should be reachable for a New Jersey examination, so an in-state location with the manager is the clean answer. If records are kept partly off-site or in the cloud, name the responsible custodian and the physical access point. DOBI must be able to examine the captive, so accessibility matters.
The common mistake is listing a location that cannot produce records on demand, which raises an examination red flag. The consequence is friction during any later exam and doubt about your controls. The misconception is that digital storage means the address does not matter; the state still wants a clear, responsible point of access.
Item 12 — Jurisdictions Where Most Risks Are Located
This item asks where the majority of the insured risks sit. List the state or states where the parent’s covered operations mostly are. For example, New Jersey and Pennsylvania for a regional manufacturer.
The nuance is honesty about geography, because this answer helps DOBI judge the “benefit to New Jersey” and how risks spread. If risks are nationwide, say so and name the top states. This does not have to be New Jersey, but the captive’s home and presence must be.
The common mistake is leaving this vague, such as writing various, which gives the reviewer nothing to assess. The consequence is a follow-up question and lost time. The misconception is that risk location must be New Jersey; it need not be, since the law limits the captive’s home and operations, not where its insureds operate.
Item 13 — Resident Registered Agent and Address
This item asks for the captive’s New Jersey registered agent. Enter the agent’s name and full in-state address. For example, NJ Corporate Agents LLC, 50 West State Street, Trenton, NJ 08608.
The nuance is that N.J.S.A. 17:47B-2 requires this agent to accept service of process, and if the agent cannot be found, the Secretary of State steps in as agent by law. The agent must have a real New Jersey address, not a mail drop in another state. This is separate from the principal office in Item 10.
The common mistake is naming an out-of-state agent or confusing this with the principal office. The consequence is non-compliance with a statutory requirement and a likely return. The misconception is that the parent’s lawyer anywhere can serve; the agent must be a New Jersey resident or qualified entity.
Item 14 — Capital and Surplus of the Company
This is one of the most important items and has many parts. Item 14(a) asks for initial capital, initial surplus, and the total; 14(b) for the amount contributed by policyholders; 14(c) for the amount from non-policyholders; 14(d) to identify those non-policyholders; and 14(e) and 14(f) for stock type, par value, share count, and where shares are held. For example, a pure captive enters Initial Capital $250,000, Initial Surplus $0, Total $250,000.
The nuance is the minimum. New Jersey expects at least $250,000 in capital and surplus for a pure captive, with higher figures for association and industrial insured captives, and the Commissioner can require more based on risk. Your figure must also match the NAIC capital and surplus logic and your business plan’s projections. Match every number here to your pro forma and your letter of credit.
The common mistake is funding below the minimum or letting the form’s numbers disagree with the business plan. The consequence is a capital-adequacy denial, since the law makes asset liquidity relative to risk a core test. The misconception is that surplus is optional; the total of capital plus surplus must clear the threshold for your captive type.
Item 15 — Letters of Credit
This item applies only if you fund capital with a letter of credit. Enter the issuing bank’s name and address, in whose favor it is issued, and the amount. For example, First Garden Bank, 10 Bank Plaza, Newark, NJ; Issued in Favor of NJ DOBI; Amount $250,000.
The nuance is that N.J.A.C. 11:28-1.3 requires an irrevocable letter of credit, and DOBI posts a sample form to follow. The letter must be irrevocable and issued by an acceptable bank, or it will not count toward your capital. If you fund fully in cash, write not applicable rather than leaving it blank.
The common mistake is submitting a revocable or expiring letter, which fails the irrevocable standard. The consequence is that the capital is treated as unfunded, sinking your Item 14 numbers. The misconception is that any bank letter works; it must match the agency’s irrevocable form and be in DOBI’s favor.
Items 16, 17, 18, and 19 — Authorizing Resolutions and Committees
These items ask about governance. Item 16 asks whether the parent prepared resolutions naming people to vote the stock and to negotiate the letter of credit, repayment, and guaranty agreements. Items 17 and 18 ask, Yes or No, whether an Audit Committee and an Executive Committee will be formed, and Item 19 asks for the Investment Committee members. For example, Item 17: Yes; Item 18: No; Item 19: Lena Okafor, Priya Shah.
The nuance is that these answers must line up with your bylaws and board resolutions. If you check Yes on the Audit Committee, your bylaws should provide for one, and the named investment members should be real, qualified people. Sound governance supports the “overall soundness of its plan of operation” test in N.J.S.A. 17:47B-2.
The common mistake is answering these boxes in a way that contradicts the bylaws, which signals weak controls. The consequence is added scrutiny and questions about oversight. The misconception is that committees are optional fluff; for many captives, the investment committee is central to how reserves are managed.
Items 20 through 25 — Required Service Providers
These items name the professional team. Enter the name, address, phone, and email for the Authorized Captive Manager (20), Law Firm and Attorney (21), Claims Handler and Underwriter (22), Authorized Certified Public Accountant (23), Authorized Actuary (24), and Reinsurance Broker or Intermediary (25). For example, Item 20 lists Garden State Captive Managers, 100 Market St., Trenton, NJ, 609-555-0140, info@gscm.com.
The nuance is that N.J.S.A. 17:47B-2 requires an appropriate number of in-state professional service providers, so New Jersey-based managers, attorneys, and accountants strengthen your file. The captive manager in Item 20 must be authorized in New Jersey, so use a registered captive manager. If a provider truly does not apply, such as a reinsurance broker for a captive that cedes nothing, write not applicable.
The common mistake is naming out-of-state-only providers or leaving a box blank. The consequence is a finding that the captive lacks the required in-state expertise, which the law treats as a licensing factor. The misconception is that one firm can fill every role; the state expects qualified, distinct professionals for each function.
Item 26 — Branch Captive Consent Statement
This item applies only to branch captives. It tells you to attach a statement from the alien captive insurance company consenting to DOBI’s examination of the alien captive in its home jurisdiction. For example, a Bermuda captive forming a New Jersey branch attaches a signed consent letter from the Bermuda parent.
The nuance is that this is a hard gate for branch captives under N.J.S.A. 17:47B-1, since New Jersey must be able to look at the alien insurer’s home books. If you are not a branch captive, simply mark not applicable. The consent must be clear and signed by an authorized officer of the alien company.
The common mistake is a branch applicant skipping this attachment, which blocks the license outright. The consequence is that DOBI cannot examine the foreign parent and cannot approve. The misconception is that the home-country regulator’s oversight is enough; New Jersey wants its own examination right in writing.
Certification and Signature Block
The final block is a sworn certification. By signing, you certify that all information is true and correct, that all estimates are honest estimates based on carefully assessed facts, and that you will notify the Commissioner within ten days of any material change. Enter the signer’s name, date, signature, and title, such as Lena Okafor, 03/01/2026, President.
The nuance is the ten-day notice duty, which lives on after filing. If ownership, capital, or management changes while the application is pending, you must tell DOBI within ten days. The signer should be an officer with authority to bind the captive.
The common mistake is signing without truly reviewing every box, or letting an unauthorized person sign. The consequence is severe, because a false statement on a sworn application can void the filing and expose the signer. The misconception is that the certification is boilerplate; it is a binding oath that carries real duties forward.
Three Filled-Out Examples Using Real Scenarios
The form looks different depending on the captive type, so three named filers show how the same boxes get answered in practice. Each table tracks one applicant through the key sections of the application.
Scenario 1 — Acme Manufacturing forms a pure captive. Lena Okafor, risk officer for a single-parent manufacturer, files to cover Acme’s product liability.
| Form Section | What Acme Manufacturing Enters |
|---|---|
| Top checkboxes | Captive Formation |
| Item 1 — Name | Acme Risk Insurance Company, Inc. |
| Item 2 — Type | Pure |
| Item 3 — Organization | Stock, formed 01/15/2026, FEIN 12-3456789 |
| Item 4 — Parent | Acme Holdings, Inc. at 100% |
| Item 9 — Officers | President Lena Okafor; VP and Secretary Marcus Bell |
| Item 13 — Registered Agent | NJ Corporate Agents LLC, Trenton, NJ |
| Item 14 — Capital and Surplus | Capital $250,000, Surplus $0, Total $250,000 |
| Item 20 — Captive Manager | Garden State Captive Managers, Trenton, NJ |
| Certification | Lena Okafor, President, 03/01/2026 |
Scenario 2 — The Tri-State Builders Group forms an association captive. Priya Shah files for a trade group that wants to pool contractor liability across its members.
| Form Section | What Tri-State Builders Group Enters |
|---|---|
| Top checkboxes | Captive Formation |
| Item 1 — Name | Tri-State Builders Captive Insurance Company |
| Item 2 — Type | Association |
| Item 3 — Organization | Reciprocal, formed 02/01/2026, FEIN 98-7654321 |
| Items 4–6 — Owners | Multiple member firms; relationship stated as unaffiliated members of the same trade association |
| Item 7 — Financials | Audited statements for each major member attached |
| Item 12 — Risk Location | New Jersey, New York, Pennsylvania |
| Item 14 — Capital and Surplus | Total $500,000 to meet association threshold |
| Item 19 — Investment Committee | Priya Shah, Dana Reyes, Tomas Vela |
| Certification | Priya Shah, President, 03/10/2026 |
Scenario 3 — Coastal Sponsor LLC forms a sponsored (cell) captive. Marcus Bell files for a sponsor that will run protected cells for unrelated participants.
| Form Section | What Coastal Sponsor LLC Enters |
|---|---|
| Top checkboxes | Captive Formation |
| Item 1 — Name | Coastal Sponsored Captive Insurance Company |
| Item 2 — Type | Sponsored |
| Item 3 — Organization | LLC, formed 01/20/2026, FEIN 45-6789012 |
| Item 4 — Parent | Coastal Sponsor Holdings LLC at 100% |
| Item 10 — Principal Office | 100 Market Street, Suite 300, Trenton, NJ |
| Item 11 — Books and Records | Manager’s office, Trenton, NJ |
| Item 14 — Capital and Surplus | Core capital $250,000 plus per-cell funding noted |
| Item 15 — Letter of Credit | First Garden Bank, in favor of NJ DOBI, $250,000 |
| Certification | Marcus Bell, Managing Member, 03/15/2026 |
How to File the Completed Form
New Jersey runs captive licensing through the Office of Captive Insurance, and the application instructions are specific about how to submit. Most filers start with a pre-filing meeting, then send the finished packet through two channels at once: one signed paper original by mail and one PDF by email.
- By mail: Send one signed original to the Office of Captive Insurance, New Jersey Department of Banking and Insurance, 20 West State Street, P.O. Box 325, Trenton, New Jersey 08625-0325. Keep proof of mailing, such as certified mail receipts, as your filing record.
- By email: Email a PDF of the complete filing to dobi.captives@dobi.nj.gov. Save the sent email and any confirmation as your digital proof of filing.
On fees, plan for several layers. The state may send the application to an outside actuary, and under N.J.A.C. 11:28-1.5 the applicant pays the actual cost of that review up to a maximum of $4,000, due within 30 days of the invoice. The Reference Guide also lists business-formation fees, such as a $125 filing fee, a $25 certified-copy fee, and a $25 expedited-handling fee for an LLC. Pay these by the method the agency directs, usually check to the Treasurer, State of New Jersey.
Processing is fast when the file is clean, and New Jersey is known for licensing in roughly 30 days. The review starts only when your packet is complete, so a returned form resets your timeline. Keep every receipt, the mailed original’s tracking, and the email confirmation as your proof that you filed and when.
What Happens After You File
Once your packet lands, the Office of Captive Insurance reviews it against the statute and may send it to an independent actuary. That outside review is advisory, but you pay for it, and the actuary tests whether your capital and reserves match your risk. Expect questions, since DOBI often asks for clarifications before it approves.
If the Commissioner is satisfied that your documents comply with N.J.S.A. 17:47B-2, the agency grants a license that runs until April 1 and is renewable each year. Your captive may not write any coverage before that license issues, so do not bind policies on assumption. Approval also confirms your in-state office, registered agent, and service-provider team pass muster.
After licensing, ongoing duties begin. The captive must hold at least one board meeting a year in New Jersey, file an annual report, and pay premium tax. The annual premium tax report is due each year and includes a $300 Certificate of Authority renewal cost, so budget for it.
Remember the ten-day rule you signed. If anything material changes, such as ownership, capital, or management, you must notify the Commissioner within ten days. Missing that notice can put your young license at risk.
Mistakes to Avoid When Filling Out the Form
Small slips on this form cause big delays, because the agency returns incomplete or inconsistent packets. Watch for these specific errors.
- Leaving any box blank instead of writing not applicable, which causes an automatic return.
- Choosing the wrong captive type in Item 2, which puts your file under the wrong legal limits and triggers rejection.
- Funding below the $250,000 minimum capital and surplus in Item 14, which fails the financial test.
- Listing an out-of-state principal office in Item 10, which violates the in-state presence rule.
- Naming an out-of-state registered agent in Item 13, which breaks the service-of-process requirement.
- Attaching unaudited or outdated owner financials for Item 7, which forces a replacement request.
- Ownership percentages in Items 4 through 6 that do not total 100 percent, which raises a control concern.
- Using a revocable or non-conforming letter of credit in Item 15, which leaves your capital unfunded.
- Naming officers in Item 9 without matching biographical affidavits, which stalls the character review.
- A branch captive skipping the Item 26 consent statement, which blocks approval outright.
- Mismatched names across the application, bylaws, and articles, which keeps the reviewer from tying documents together.
- Signing the certification without authority or without reviewing the file, which can void the sworn filing.
Do’s and Don’ts
A few habits keep your application moving and keep DOBI on your side. Each point has a reason behind it.
Do: – Do hold a pre-filing meeting with the Office of Captive Insurance, because early feedback prevents costly returns. – Do write not applicable in any box that does not apply, since the form forbids blanks. – Do match every number and name to your business plan, bylaws, and articles, because mismatches stall review. – Do use New Jersey-based service providers, since the statute requires in-state expertise. – Do keep proof of both mailing and email, because that is your record of filing date. – Do re-download a fresh form before filing, since DOBI can update the version without a clear date stamp.
Don’t: – Don’t bind any insurance before the license issues, because writing business early breaks the law. – Don’t underfund capital to save cash, since it fails the core adequacy test and sinks the file. – Don’t list the parent’s out-of-state HQ as the principal office, because it contradicts the domicile rule. – Don’t name placeholder officers, since each must pass a character and experience check. – Don’t ignore the ten-day change notice, because silence can endanger your license. – Don’t submit a revocable letter of credit, since only an irrevocable one counts as capital.
Pros and Cons of Filing on Your Own vs. With a Captive Manager
Most New Jersey captives file with a licensed captive manager and attorney, but some sophisticated parents try to self-file. Weigh the trade-offs before you decide.
| Filing With a Captive Manager and Attorney | Filing Largely on Your Own |
|---|---|
| Pros: Knows the form’s traps, so fewer returns and faster approval. | Pros: Lower upfront professional fees if you already have deep expertise. |
| Pros: Provides the in-state presence the statute requires, satisfying the law. | Pros: Full internal control over the timeline and messaging. |
| Pros: Builds the actuarial study and business plan that survive review. | Pros: Direct relationship with DOBI for those who file often. |
| Pros: Handles ongoing reports and the ten-day notice duty, lowering risk. | Pros: Useful for a simple pure captive with a clean structure. |
| Pros: Often shortens the path to the 30-day license, saving time. | Pros: Can work when your team already includes captive professionals. |
| Cons: Adds professional fees on top of state and review costs. | Cons: High odds of a returned packet, since blanks and mismatches are easy to make. |
| Cons: Less day-to-day control if the manager is slow to respond. | Cons: May fail the in-state expertise requirement, risking denial. |
| Cons: Quality varies, so the manager must be carefully chosen. | Cons: One signature on a sworn form carries real legal exposure if wrong. |
FAQs
Do I have to file the application before my captive can sell any insurance?
Yes. New Jersey law bars a captive from writing any business in the state until the Commissioner grants a license, so no coverage can be bound before approval.
Do I need to download a fresh copy of the form each time?
Yes. The form lacks a clear revision date, so pulling a current copy from the DOBI site avoids filing an outdated version that could be returned.
Do I leave a box blank if a question does not apply to me?
No. The instructions say to write not applicable instead, because any blank box causes the agency to return the whole application.
Do I check both the Formation and Redomestication boxes at the top?
No. You check only one; Formation for a new captive and Redomestication only when moving an existing captive into New Jersey.
Do the ownership percentages in Items 4 through 6 have to total 100 percent?
Yes. The percentages must add to 100, and any layered holding company must be disclosed, or DOBI will question who controls the captive.
Do I write my parent’s out-of-state headquarters in Item 10 for the principal office?
No. The principal office must be in New Jersey, often the captive manager’s in-state office, because the law requires an in-state presence.
Do I list the registered agent and the principal office in the same box?
No. Item 13’s registered agent and Item 10’s principal office are separate; the agent accepts service of process at a New Jersey address.
Do I need at least $250,000 in capital and surplus for a pure captive?
Yes. New Jersey expects a minimum of $250,000 for a pure captive, with higher amounts for association captives and more if the Commissioner requires it.
Do I have to use an irrevocable letter of credit in Item 15?
Yes. Only an irrevocable letter of credit on the agency’s sample terms counts toward capital, so a revocable one will not be accepted.
Do all the officers I name in Item 9 need biographical affidavits?
Yes. Each incorporator, officer, and director needs a biographical affidavit, so name only people ready to pass a character and experience check.
Do I file Item 26 if my captive is not a branch captive?
No. Item 26’s alien-insurer consent statement applies only to branch captives; everyone else marks it not applicable.
Do I submit the form only by email?
No. You submit one signed paper original by mail to Trenton and email a PDF to dobi.captives@dobi.nj.gov, keeping proof of both.
Do I have to tell DOBI if something changes after I file?
Yes. The signed certification requires you to notify the Commissioner within ten days of any material change in the filed information.
Do I have to pay for the outside actuary review?
Yes. If DOBI sends your file to an independent actuary, you pay the actual cost up to $4,000 within 30 days of the invoice.
Related reading
- How to Fill Out Pennsylvania Captive Insurance Application (w/Examples) + FAQs
- How to Fill Out the New Jersey DOBI Business Entity Producer License + FAQs
- How to Fill Out the New Jersey DOBI Insurance Producer License Application + FAQs
- How to Fill Out the New Jersey DOBI Money Transmitter License Application (+ FAQs)
- How to Fill Out the New Jersey DOBI Public Adjuster License Application (w/Examples) + FAQs
- How to Fill Out the Utah Captive Insurance Company Application + FAQs
- How to Fill Out the Montana Captive Insurance Company Application + FAQs