How to Fill Out the Pure Captive Insurance Application (w/Examples) + FAQs

The Florida Application for Captive Insurer (Form OIR-C1-2114) is the form a company files with the Florida Office of Insurance Regulation to license a pure captive insurance company that insures the risks of its own parent and affiliates. A pure captive is a wholly owned insurance subsidiary that writes coverage only for the business that owns it, so the form proves to the state that the new insurer has enough money, a sound plan, and trustworthy people behind it. You file it under Rule 69O-136.005 and Chapter 628, Part V of the Florida Statutes, and the version in use carries a revision date of 5/17 printed at the bottom of every page.

Get one line wrong, leave out the actuarial study, or short the capital account, and the Office will disapprove or return the filing instead of approving it. Captive formation is a small but serious club: the U.S. captive market holds roughly $50 billion in annual premium and thousands of licensed entities, yet a single missing biographical affidavit or unverified bank letter can push your license date back by months. This guide walks you through the form section by section, in plain language, so you file it right the first time.

• 📋 How to complete every section of Form OIR-C1-2114, from the captive’s name to the notarized certification.
• 💵 The exact minimum capital and surplus a pure captive stock or mutual insurer must show, and how to verify the funds.
• 🧮 What goes inside the business plan, the three-year pro formas, and the independent actuarial feasibility study.
• 🧑‍⚖️ Which supporting forms, affidavits, fingerprint cards, and background reports must travel with the application.
• ⚠️ The field-level mistakes that get captive applications returned, and how to avoid each one.

What the Form Is and Who Must File It

Form OIR-C1-2114, the Application for Captive Insurer, is the master licensing application that the Florida Office of Insurance Regulation requires before any captive insurer can transact business in the state. The form is authorized by Rule 69O-136.005 of the Florida Administrative Code and sits on top of the Captive Insurance statute in Chapter 628, Part V. You must file it if you intend to form a pure captive, a reinsurance captive, an industrial insured captive, or a special purpose captive with a Florida home office. This article focuses on the pure captive, the most common type, because it is owned by one parent and insures only that parent group’s risks.

A pure captive is not a tax shelter on its own, and it is not a commercial insurer that sells policies to the public. It is a regulated insurance company that a business builds to formalize and fund its own risk. The agency that receives the form is the Office of Insurance Regulation, the deadline is set by your requested licensing date inside the business plan, and the penalty for an incomplete filing is plain: the Office will return or deny it, and you cannot legally write a single policy until the certificate of authority issues.

Many filers also pursue a federal tax election under Section 831(b) of the Internal Revenue Code, which lets a small captive with net written premium under the annual cap (around $2.85 million, indexed for inflation) be taxed only on investment income. That election is separate from the state application and is made on the captive’s federal tax return, not on Form OIR-C1-2114. The IRS watches small captives closely under Notice 2016-66, which can make certain micro-captive arrangements reportable transactions on Form 8886, so a poorly designed captive can draw an audit even after the state approves it.

The typical filer is not the business owner working alone. It is a captive manager or insurance attorney completing the form on behalf of a parent company’s chief financial officer or risk manager. These filers are sophisticated, but the form is dense and unforgiving, so the goal here is to make every box clear and every consequence visible.

Before You Start: Documents and Information You Need

Captive applications fail more often from missing attachments than from wrong answers in the boxes. Gather everything below before you open the form, because the Office reviews the package as a whole and returns it if any required piece is absent. Build a checklist and tick each item off.

• Proposed captive name and entity type. You need the exact legal name you will register with Sunbiz, the Florida Division of Corporations; if the name is taken or too close to an existing insurer, the filing stalls.
• Parent and beneficial owner financials. Collect the parent’s latest annual report, 10-K, or personal financial statements for any owner of 10% or more, because the Office tests whether the parent can stand behind the captive.
• Independent actuarial feasibility study. A qualified outside actuary must produce this before you file; without it the business plan has nothing to tie to and the application is incomplete.
• Three-year pro forma financial statements. Prepare these on the NAIC UCAA ProForma template (Form 13), since the Office compares your projections to the feasibility study line by line.
• Bank verification letter. You need a signed letter from an officer of the bank holding the capital, confirming the funds are not encumbered, hypothecated, or pledged; a generic balance screenshot will not do.
• Biographical affidavits and SSNs. Each officer and director needs an NAIC Biographical Affidavit (Form OIR-C1-1423) with original notary seal, plus a separate confidential page listing name and Social Security number.
• Background reports and fingerprint cards. Order NAIC-vendor background reports and register each officer and director for fingerprinting through IdentoGO before or with the filing, or processing pauses.
• Articles of Incorporation and Bylaws. Have an unexecuted copy of the Articles and an executed, secretary-signed copy of the Bylaws ready, because the Office must endorse the Articles before they go to the Secretary of State.
• The $1,500 filing fee. Cut the check to the Florida Department of Financial Services and attach a copy of the Application for Captive Insurer Invoice; the filing is not complete without proof of payment.
• The captive’s EIN. Obtain the federal Employer Identification Number from the IRS in advance, because Section G-2 asks for it and you cannot leave it blank.

Each missing item carries the same consequence: the Office treats the package as incomplete and either returns it or starts a clock on a deficiency letter, both of which delay your licensing date and may force you to re-pay vendors.

Where to Get the Form and How to Access It

The official Application for Captive Insurer lives on the Florida Office of Insurance Regulation website as Form OIR-C1-2114. You can pull the current PDF directly from the captive insurer application page, and you should confirm the revision date 5/17 in the footer so you know you have the version tied to Rule 69O-136.005. Do not use a copy you found on a third-party blog, because outdated versions ask for different attachments and the Office may reject the wrong form.

You complete and submit the package through the Office’s online portal, called iApply, by selecting iApply – Online Company Admissions. The portal lets you upload the form and every supporting document as PDFs, which the form expressly allows in place of original paper for most items. Two items still travel outside the portal: the filing-fee check, which mails to the Department of Financial Services in Tallahassee, and the paper fingerprint cards for non-residents, which mail to the Office’s Fingerprint Card Processing room.

Several attachments are NAIC uniform forms rather than Florida forms, and you download those from the NAIC UCAA page. These include the Uniform Consent to Service of Process (Form 12, OIR-C1-1524), the Biographical Affidavit (Form 11, OIR-C1-1423), the Lines of Insurance form (Form 3, OIR-C1-1416), and the ProForma Financial Statements (Form 13, OIR-DO-896). Pull each one fresh, because the NAIC updates them and the Office matches the revision dates.

If you hit a snag in the portal or a question about the package, the Office routes captive (property and casualty) questions to pcappcoord@floir.com. Keeping that contact handy saves you from guessing when a field is unclear, and a quick email is far cheaper than a returned application.

Step-by-Step: How to Fill Out the Application for Captive Insurer Line by Line

The form runs from Section A through Section H. Complete the sections in order, because later sections (financials, business plan, legal documents) depend on decisions you lock in early (entity type and ownership). Below is one walkthrough per field or grouping, using named filers so you can see exactly what goes in each box.

Section A – Name of Proposed Captive

This field asks for the full legal name of the insurance company you are forming. Enter the name exactly as it will appear on the Articles of Incorporation and the Sunbiz registration, including the corporate ending such as Inc. or Corp. For example, Gulfstream Bottling Pure Captive, Inc. is the entry Maria Reyes, the captive manager for a Tampa beverage maker, types here. If the parent already reserved the name with the Florida Division of Corporations, use the reserved spelling letter for letter, even a comma. A common mistake is entering a trade name or “doing business as” version instead of the legal name, which creates a mismatch that delays the Articles endorsement and the Secretary of State filing. Many filers wrongly believe the captive can share the parent’s exact name; it cannot, because the captive is a separate insurer and the name must be distinct enough for the Office to tell them apart.

Section A – Type of Proposed Captive

This field asks you to check one box describing the kind of captive: Pure, Reinsurance, Industrial Insured, or Special Purpose. Check the single box that matches your structure; for a captive that insures only its own parent and affiliates, check Pure. Maria checks Pure for Gulfstream Bottling because the captive will write coverage only for the bottling company and its subsidiaries. If your captive will insure unrelated members in a group, Pure is the wrong box and you likely need Industrial Insured with industry information attached. The most common mistake is checking more than one box or checking Pure when outside risk is involved, which triggers the wrong capital requirement and a deficiency letter. Filers often believe the type can be changed later with a quick amendment; in practice, the type drives your minimum capital and your whole plan of operation, so picking wrong means refiling.

Section A – Form of Organization

This field asks how the captive is legally organized: Stock, Mutual, Incorporated Non-Profit, or Other. Check the one form that matches your Articles of Incorporation; most pure captives are Stock companies owned by a single corporate parent. Maria checks Stock because Gulfstream Bottling will own 100% of the captive’s shares. If you choose Mutual, your capital is funded through contributed surplus from policyholders rather than paid-in capital, which changes Section B. A frequent error is checking Stock while the Articles describe a non-stock structure, an inconsistency the Office flags immediately. Some filers assume Mutual lowers their capital needs, but a pure captive mutual must show $250,000 in unimpaired surplus, which can exceed the stock minimums when combined.

Section A – Principal Place of Business and Books and Records

This field asks for the captive’s principal place of business and the location of its books and records, with both addresses if they differ. Enter a full Florida street address, not a P.O. Box, because the form states the captive must maintain its principal place of business in this state. Maria lists the Tampa office of the captive’s manager as both the principal place and the records location. If your captive manager keeps the books at a different Florida address, list both. The common mistake here is naming an out-of-state address tied to the parent, which violates the residency requirement and stops the review cold. Filers sometimes think a registered agent address satisfies this; it does not, because the records location must be a real place where examiners can review documents.

Section A – Registered Agent for Service of Process

This field asks for the name and address of the registered agent for service of process and requires an executed Uniform Consent to Service of Process. Name an individual (Florida lists an individual, not just a company) and attach Form OIR-C1-1524, the Uniform Consent to Service of Process. Maria names the captive’s Florida attorney, Daniel Cho, Esq., with his Tampa office address, phone, and email, and attaches the signed consent with the FL box marked on Exhibit A. If you skip the executed consent form, the Office cannot accept service on the captive’s behalf. The common mistake is listing the agent but forgetting Form 12, which renders the appointment legally void. Many filers think the chief financial officer alone covers service of process; Florida wants a named individual in addition to the CFO.

Section A – Parent and Beneficial Owners

This grouping asks for the name, address, ownership percentage, and contact details of the parent and every beneficial owner holding 10% or more. List the parent first, then each 10%-or-more owner on the rows provided, attaching extra sheets if needed. Maria enters Gulfstream Bottling Holdings, LLC as parent at 100% ownership, with its corporate address and CFO contact. You must also attach the parent’s latest annual report, 10-K, or personal financial statements so the Office can judge financial strength. The common mistake is omitting an indirect owner who crosses the 10% line through a holding company, which looks like concealment and triggers extra scrutiny. Filers often assume only direct shareholders count, but beneficial ownership reaches through layers, so trace the chain to the real humans.

Section A – Relationship Among Parent and Beneficial Owners

This field asks you to explain the relationship among the parent and the beneficial owners. Describe in plain sentences how each owner connects, attaching an organizational narrative if the structure is complex. Maria writes that Gulfstream Bottling Holdings, LLC wholly owns the operating company and will wholly own the captive, making the captive a sister entity to the bottling business. If ownership runs through trusts or multiple LLCs, spell out each link. The common mistake is a one-word answer like “subsidiary,” which forces a follow-up question and delays review. Filers sometimes believe the organization chart in Section C-5 replaces this narrative; the form wants both, because the chart shows structure and this field explains intent.

Section A – Contact, Incorporators, Directors, and Officers

This grouping asks for the application contact person, the incorporators, the directors, and the officers of the proposed captive. Name a single contact for the filing, then list incorporators (Florida requires at least three, two of whom must be Florida residents), directors (at least one Florida resident), and officers with their positions. Maria names herself as contact, lists three incorporators including two Tampa residents, and names the captive’s president and secretary among the officers. Each director and officer needs a Biographical Affidavit (Form OIR-C1-1423) attached. The common mistake is listing zero or one Florida-resident incorporator, which violates Section E-1 and blocks the Articles endorsement. Filers often think the parent’s executives can fill these roles from out of state; the residency rule means you usually add a local director and resident incorporators.

Section B-1 – Sworn Financial Statement

This field requires a statement of the captive’s financial condition sworn under oath by its President and Secretary. Prepare an opening financial statement showing assets, capital, and surplus, then have both officers sign under oath before a notary. For Gulfstream’s captive, the president and secretary swear to a statement showing $250,000 in cash held at the funding bank. The statement must match the numbers you enter in Section B-2 and the bank verification letter. The common mistake is a statement signed by only one officer or left un-notarized, which the Office rejects as defective. Filers sometimes assume a draft balance sheet from the actuary suffices; the form wants a sworn statement from the company’s own officers.

Section B-2 – Capital and Surplus

This field asks for the captive’s initial capital, initial surplus, and total, plus the form and source of those funds. Enter the dollar amounts and identify the financial institution holding them, describing the form (cash, securities, or letter of credit). Maria enters Initial Capital $100,000, Initial Surplus $150,000, Total $250,000 for Gulfstream’s pure captive stock insurer, naming the holding bank and officer. A pure captive stock insurer must show at least $100,000 unimpaired paid-in capital and $150,000 unimpaired surplus; a pure captive mutual insurer must show $250,000 unimpaired surplus. The common mistake is funding only the capital and forgetting the surplus, which leaves the captive below the statutory floor and forces a return. Filers often believe a pledge or future commitment counts as paid-in capital; the funds must be on deposit and unencumbered now.

Section B-2 – Stock Details and Letter of Credit

This grouping asks for the type and number of authorized shares, par value, selling price, share location, and any letter of credit used for funding. Enter the share classes, the par value stated in the Articles or board minutes, and where the certificates are held; if a letter of credit funds the captive, give the amount and issuing bank, made out in favor of the Florida Office of Insurance Regulation. Gulfstream authorizes 1,000 shares at $100 par, held by the parent, and uses cash rather than a letter of credit. If you do use a letter of credit, it must be clean and irrevocable. The common mistake is naming the wrong beneficiary on the letter of credit, which makes it worthless to the Office. Filers sometimes think any bank guarantee qualifies; the Office expects an evergreen, irrevocable letter naming itself as beneficiary.

Section C-1 – Plan of Operation

This field asks for a written three-year business plan covering management, products, reinsurance, and pro formas, tied directly to the feasibility study. Write a plan that names each manager by area (marketing, underwriting, rating, reserving, reinsurance, claims, accounting, investments) and states a requested licensing date. Maria’s plan names the captive manager for underwriting and accounting, the parent’s risk manager for loss control, and an outside actuary for reserving, requesting a licensing date 90 days out. The narrative must match the numbers in the pro formas and the feasibility study. The common mistake is a plan that lists premium figures the actuarial study never supports, an instant red flag for the reviewer. Filers often treat the plan as boilerplate; the Office reads it as a binding description of how the captive will actually run.

Section C-1(B) – Insurance Products and Lines

This subsection asks for a description of each line of insurance, the risks, policy limits, and deductibles, plus the NAIC Lines of Insurance form. List every coverage the captive will write, with limits and deductibles, and complete Form OIR-C1-1416 (UCAA Lines of Insurance, Form 3) for Florida only. Gulfstream’s captive lists general liability with a $1,000,000 limit and a $25,000 deductible and commercial property for warehouse equipment. Describe the actual risks inside each line, not just the line name. The common mistake is checking lines on Form 3 that the business plan never explains, which creates a coverage gap the Office questions. Filers sometimes assume a captive can write any line later; you can only write what the certificate of authority approves.

Section C-1(C) – Reinsurance

This subsection asks for the planned use of reinsurance, including purpose, retentions, limits, catastrophe cover, and the largest amount retained on any one risk. State whether the captive cedes risk above a retention and to whom, with the limits of liability. Gulfstream’s captive retains the first $250,000 per claim and cedes the layer above to a licensed reinsurer, keeping catastrophe protection for property. If you use no reinsurance, say so and explain why the retained risk is safe. The common mistake is omitting the largest single-risk retention, a number the Office uses to test solvency. Filers often believe reinsurance is optional detail; it is central to proving the captive will not be wiped out by one large loss.

Section C-1(D) – Pro Forma Financial Statements

This subsection asks for three years of pro forma financials on the NAIC UCAA ProForma template, with assumptions and projections per line. Build the pro formas on Form OIR-DO-896 (Form 13), projecting premium, losses, expenses, and surplus for each line and stating the assumptions behind every number. Maria’s pro formas show premium of $400,000 in year one rising with the parent’s growth, tied to the actuary’s expected-loss assumptions. Excluding the assumptions is fatal, because the reviewer cannot test the math. The common mistake is using a generic spreadsheet instead of the NAIC template, which the Office may not accept. Filers sometimes pad year-one surplus to look strong; inflated assumptions that the study does not support invite rejection.

Section C-2 and C-3 – Assets-to-Risk Ratio and Feasibility Study

This grouping asks for a statement of the captive’s quantifiable assets-to-risk ratio and an independent actuarial/feasibility study. Provide the ratio of assets to assumed risk, then attach a study by an outside consultant showing expected and worst-case pro formas over at least three years, with premium income and its basis. Gulfstream’s study, signed by a credentialed actuary, shows the captive stays solvent even in a worst-case loss year. Indicate whether the figures are statutory or GAAP. The common mistake is submitting a study written by an insider rather than an independent consultant, which the Office discounts. Filers often think the feasibility study and the business plan are the same document; they are separate, and the plan must tie to the study.

Section C-4, C-5, C-6 – Due Diligence, Org Chart, and Verification of Funds

This grouping asks for loss-prevention due diligence on the parent, an organizational chart, and verification that the required funds exist. Attach evidence that you evaluated the parent’s loss-control programs, a diagram of all parent entities and states of incorporation, and a bank officer’s letter verifying the funds. The letter must state the depositor name and FEIN, account numbers and amounts, the form of funds, any CD numbers and maturity dates, and that the funds are not encumbered, hypothecated, or pledged. Gulfstream’s bank letter confirms $250,000 in an unencumbered operating account. The common mistake is a bank letter missing the unencumbered language, which fails to prove the capital is real. Filers sometimes submit an online balance printout; the Office requires a signed letter from a bank officer.

Section D – Service Providers

This section asks for the captive’s management firm, attorney, claims administrator, certified public accountant, actuary, reinsurance broker, and any other providers. List each provider’s name, address, phone, email, and contact person, and attach a broker-of-record letter if you name a reinsurance broker. Maria lists the captive management firm, attorney Daniel Cho, the CPA firm, and the actuary who wrote the feasibility study. Florida separately authorizes captive managers, actuaries, and CPAs, so these names should match approved providers. The common mistake is naming a provider who is not authorized in Florida, which forces a substitution mid-review. Filers often leave the actuary line blank, assuming the study covers it; the Office wants the actuary identified here too.

Section E – Articles of Incorporation and Bylaws

This section asks for an unexecuted copy of the Articles of Incorporation and an executed copy of the Bylaws. Submit draft Articles for the Office to endorse before they go to the Florida Secretary of State, and submit Bylaws signed and dated by the corporate secretary. The Articles must name no fewer than three incorporators, at least two Florida residents, matching Section A. Gulfstream files draft Articles showing three incorporators and signed Bylaws from secretary Daniel Cho. The Office endorses the Articles, you file them with Sunbiz, and the license issues only after the Office receives the certified Articles and a Certificate of Status. The common mistake is filing executed Articles with the Secretary of State before the Office endorses them, which can force a costly amendment. Filers often think the Bylaws are optional; the form requires the executed, secretary-signed copy.

Section F – Biographical Affidavits, Background Reports, Fingerprints, and Attestation

This section requires a Biographical Affidavit, a background investigative report, and fingerprint cards for each officer and director, plus an attestation of compliance with Section 628.906. Submit Form OIR-C1-1423 for each person with original signature and notary seal, putting each SSN on a separate page marked CONFIDENTIAL. Order background reports through an NAIC-listed vendor that emails results directly to bkgrnd-inv@floir.com, and register each person for fingerprinting at IdentoGO. Gulfstream’s president and secretary each complete an affidavit, order a report, and schedule digital prints as Florida residents. The common mistake is putting the SSN directly on the affidavit instead of the separate confidential page, which the Office must then handle as a privacy issue. Filers sometimes wait to order background reports until after filing; the reports must arrive before or with the application.

Section G and H – Fees, EIN, and Notarized Certification

This grouping asks for the $1,500 licensing fee, the captive’s EIN, and a notarized certification signed by an officer or director. Attach a copy of the Application for Captive Insurer Invoice and mail the original check to the Department of Financial Services in Tallahassee, enter the captive’s EIN in Section G-2, and have an officer sign the Section H certification before a notary. Maria signs as the authorized officer, the notary completes the acknowledgment, and she attaches the invoice copy. The common mistake is submitting the package without proof of the fee, which leaves the filing incomplete. Filers often believe the fee can follow later; the form treats the check copy as part of a complete submission.

Three Filled-Out Examples Using Real Scenarios

The three scenarios below show how different businesses complete the same form. Each follows one filer through the major sections so you can see how entity type and risk drive the answers.

Scenario 1 — Maria Reyes, captive manager for a single-parent beverage company (pure captive stock insurer)

Form Section	What Maria Enters
Name of Proposed Captive	Gulfstream Bottling Pure Captive, Inc.
Type of Captive	Pure
Form of Organization	Stock
Principal Place of Business	Tampa, FL office of the captive manager
Parent and Ownership	Gulfstream Bottling Holdings, LLC, 100%
Capital and Surplus	Capital $100,000 / Surplus $150,000 / Total $250,000
Lines of Insurance	General liability and commercial property
Feasibility Study	Independent actuary, statutory basis, three-year pro formas
Filing Fee	$1,500 to Department of Financial Services

Scenario 2 — Dr. Anita Banerjee, owner of a physician group forming a med-mal captive (831(b) electing small insurer)

Form Section	What Anita Enters
Name of Proposed Captive	Bayshore Physicians Captive, Inc.
Type of Captive	Pure
Form of Organization	Stock
Principal Place of Business	Miami, FL records office
Parent and Ownership	Bayshore Medical Group, P.A., 100%
Capital and Surplus	Capital $100,000 / Surplus $200,000 / Total $300,000
Lines of Insurance	Medical professional liability
Reinsurance	Retains $250,000 per claim, cedes excess layer
Federal Tax Note	Plans an 831(b) election on the federal return

Scenario 3 — Carlos Mendez, CFO of a logistics firm using a letter of credit (pure captive stock insurer)

Form Section	What Carlos Enters
Name of Proposed Captive	Suncoast Logistics Captive, Inc.
Type of Captive	Pure
Form of Organization	Stock
Principal Place of Business	Orlando, FL office of records
Parent and Ownership	Suncoast Freight Holdings, Inc., 100%
Capital Funding	Cash plus an irrevocable letter of credit in favor of the Office of Insurance Regulation
Lines of Insurance	Auto liability and cargo
Service Providers	Captive manager, attorney, CPA, and actuary all named
Certification	Signed by Carlos before a notary in Orange County

How to File the Completed Form

Florida wants the application filed through one main channel, with two items that travel by mail. Choose the right path for each piece and keep proof of everything.

• Online portal (primary). Submit the full package through iApply by selecting iApply – Online Company Admissions, uploading the form and all attachments as PDFs; there is no portal fee, and processing typically runs several weeks to a few months depending on completeness. Save the iApply confirmation as your proof of filing.
• Filing fee by mail. Mail the original $1,500 check, payable to the Florida Department of Financial Services, with the invoice to the Department of Financial Services, Bureau of Financial Services, P.O. Box 6100, Tallahassee, FL 32314-1600; accepted payment is a check, and you keep a redacted photocopy as proof.
• Background reports by email. Have your NAIC-listed vendor email reports in Microsoft Word format directly to bkgrnd-inv@floir.com with the applicant named in the subject line, and upload proof the reports were ordered into iApply.
• Fingerprints. Florida residents schedule digital prints through IdentoGO; non-residents mail completed paper cards with a cover letter to the Office’s Fingerprint Card Processing, Room B-50 Larson Building, 200 East Gaines Street, Tallahassee, FL 32399-0326, and keep the IdentoGO payment confirmation.

Do not mail application paperwork with the fingerprint cards, because the form warns that mixing them delays processing. Keep a complete copy of the whole package, the iApply confirmation, the check photocopy, and the IdentoGO receipt, since these are your only proof if the Office asks what you sent.

What Happens After You File

After you submit, the Office of Insurance Regulation reviews the package for completeness first and substance second. If anything is missing, you receive a deficiency letter or the filing is returned, and the clock on your requested licensing date effectively resets until you cure the gap. A clean, complete pure captive application moves faster, often within a couple of months, while a thin one can drag for half a year.

During substantive review, examiners test the capital against the statutory floor, read the business plan against the feasibility study, and run the background and fingerprint results on every officer and director. They may ask follow-up questions about reinsurance, the assets-to-risk ratio, or an owner’s financials. Answer quickly and in writing, because each round of questions adds time.

Once the Office is satisfied, it endorses your Articles of Incorporation and sends them toward the Florida Secretary of State. You then file the endorsed Articles with Sunbiz, obtain a Certificate of Status, and return certified copies to the Office. Only after the Office receives the executed, certified Articles does it issue the certificate of authority that lets the captive write its first policy.

After licensing, the captive enters ongoing compliance. Pure captives file an annual report (Florida uses a captive annual report), pay renewal fees, maintain the minimum capital and surplus, and keep books and records in Florida for examination. If you also made an 831(b) election, watch the federal premium cap and the reportable-transaction rules under Notice 2016-66, because a lapse there is a federal problem, not a state one.

Mistakes to Avoid When Filling Out the Form

• Checking the wrong captive type in Section A; it sets the wrong capital floor and forces a refiling.
• Funding only the capital and skipping the surplus; the captive falls below the statutory minimum and the filing is returned.
• Using a P.O. Box or out-of-state address for the principal place of business; it violates the Florida residency rule and stops review.
• Listing a registered agent without attaching the Uniform Consent to Service of Process; the appointment is legally void.
• Putting Social Security numbers on the Biographical Affidavit instead of a separate confidential page; it creates a privacy defect the Office must fix.
• Submitting a feasibility study written by an insider rather than an independent actuary; the Office discounts it and asks for a new one.
• Filing pro formas on a generic spreadsheet instead of the NAIC ProForma template; the format may be rejected outright.
• Omitting the parent’s financial statements; the Office cannot judge whether the parent can stand behind the captive.
• Ordering background reports after filing instead of before or with it; processing pauses until the reports arrive.
• Naming the wrong beneficiary on a letter of credit; the funding fails because the letter does not protect the Office.
• Listing fewer than two Florida-resident incorporators or no Florida-resident director; the Articles cannot be endorsed.
• Submitting the package without a copy of the paid $1,500 invoice; the filing is treated as incomplete.

Do’s and Don’ts

Do: – Confirm the form’s 5/17 revision date before you start, because an old version asks for the wrong attachments. – Build the business plan and pro formas to tie line by line to the independent feasibility study, since the Office cross-checks them. – Fund both capital and surplus and verify the funds with a signed bank-officer letter, because unverified money fails the test. – Use the exact legal name across the form, Articles, and Sunbiz, so nothing triggers a mismatch. – Keep proof of the iApply submission, the fee check, and the fingerprint payment, because these are your only filing evidence. – Email questions to pcappcoord@floir.com when a field is unclear, since a quick answer beats a returned application.

Don’t: – Don’t file executed Articles with the Secretary of State before the Office endorses them, or you may need a costly amendment. – Don’t mail application paperwork with the fingerprint cards, because the form warns it delays processing. – Don’t pad pro forma surplus with assumptions the actuary never supported, since inflated numbers invite rejection. – Don’t assume Pure is always the right type when any outside risk is involved, because that changes your capital and plan. – Don’t leave the EIN or contact person blank, because incomplete identity fields stall the review. – Don’t use a third-party copy of the form, since outdated versions ask for different items the Office will reject.

Pros and Cons of Filing on Your Own vs. With a Captive Manager

Pros of using a captive manager or attorney: – They know the 5/17 form and the NAIC attachments, so they avoid the format errors that get filings returned. – They coordinate the actuary, CPA, and bank letter, which keeps the package internally consistent. – They satisfy Florida residency and service-provider rules, since many managers are based in the state. – They speed deficiency responses, because they speak the Office’s language and answer questions fast. – They flag federal 831(b) and Notice 2016-66 risks that a do-it-yourself filer may miss.

Cons of using a captive manager or attorney: – Professional fees add real cost on top of the $1,500 filing fee and the capital you must commit. – You depend on a third party’s timeline, which can slow you if they juggle many clients. – You may lose some hands-on understanding of your own captive’s mechanics. – A weak manager can still produce a returned application, so the choice of firm matters. – Ongoing management contracts can lock you into annual costs beyond formation.

FAQs

Do I have to maintain the captive’s principal place of business in Florida?

Yes. The form states a captive must keep its principal place of business in this state, so you enter a real Florida street address, not a P.O. Box or an out-of-state parent address.

Can I check more than one captive type in Section A?

No. You check exactly one box. The type you choose sets your minimum capital and your plan of operation, so checking two triggers a deficiency letter.

Is the $100,000 capital figure the only money a pure captive stock insurer needs?

No. A pure captive stock insurer needs $100,000 unimpaired paid-in capital and $150,000 unimpaired surplus, for $250,000 total, all on deposit and unencumbered.

Do I write the Social Security number directly on the Biographical Affidavit?

No. You put each affiant’s name and SSN on a separate page marked CONFIDENTIAL and attach it, because Florida law keeps Social Security numbers exempt from public records.

Do I list the captive’s legal name or a trade name in the first box?

Yes to the legal name. Enter the full legal name exactly as it appears on the Articles and Sunbiz, including the corporate ending, not a trade or “doing business as” name.

Can the parent’s exact name be used for the captive?

No. The captive is a separate insurer and its name must be distinct enough for the Office to tell it apart from the parent, so add a word like Captive.

Do I need an independent actuary for the feasibility study?

Yes. The study must come from an independent outside consultant. A study written by an insider is discounted, and the Office will ask you to refile it.

Is the filing fee refundable if my application is denied?

No. The $1,500 application filing fee is paid when you file and is not returned if the Office disapproves or returns the package, so submit a complete filing.

Can I file the form on paper instead of online?

No for the main package. You submit through the iApply portal as PDFs, though the fee check and non-resident fingerprint cards still travel by mail to Tallahassee.

Do I need the EIN before I file?

Yes. Section G-2 asks for the captive’s EIN, so obtain it from the IRS in advance, because you cannot leave the field blank in a complete filing.

Can I write any line of insurance once licensed?

No. The captive may write only the lines approved on its certificate of authority, so list every intended line on the form and the NAIC Lines of Insurance form.

Does the 831(b) tax election go on this state form?

No. The Section 831(b) election is a federal choice made on the captive’s tax return, separate from Form OIR-C1-2114, and it carries its own IRS reporting rules.

Do I file the Articles with the Secretary of State before submitting the application?

No. You submit unexecuted Articles for the Office to endorse first, then file the endorsed Articles with Sunbiz and return certified copies before the license issues.

Are two Florida-resident incorporators really required?

Yes. The captive must have at least three incorporators, at least two of whom are Florida residents, and at least one director must also be a Florida resident.