How to Fill Out the Tennessee Captive Insurance Company Application + FAQs

The Tennessee Captive Insurance Company License Application is the form a business uses to ask the Tennessee Department of Commerce & Insurance (TDCI) Captive Insurance Section for a Certificate of Authority to run its own insurance company under the Revised Tennessee Captive Insurance Act. A captive is an insurance company that a parent business owns to insure its own risks, and Tennessee is one of the fastest-growing captive homes in the country.

Getting this form right matters. The application moves through TDCI staff, a reviewing actuary, and finally the Commissioner, and a weak Plan of Operation or a capital figure that falls short can stall or sink the whole filing. TDCI lists the full licensure path at roughly 30 days when the package is clean, so the work you do up front saves weeks later.

Here is what you will learn in this guide:

• 🧾 What the application is, who must file it, and the law that drives it
• 💵 The exact fees, capital minimums, and deadlines you must hit
• ✍️ A line-by-line walkthrough of every major section of the form
• 👥 Three full filled-out examples using real-world business scenarios
• ⚠️ The most common mistakes that get applications delayed or denied

What the Form Is and Who Must File It

The Tennessee Captive Insurance Company License Application is a request for a Certificate of Authority, which is the legal license that lets a captive transact insurance in the state. You file it with the TDCI Captive Insurance Section, the unit that regulates captives day to day. The law behind it is the Revised Tennessee Captive Insurance Act, found at Tenn. Code Ann. Title 56, Chapter 13.

Any business that wants to form a captive in Tennessee must file this form before it writes a single policy. That includes a single company forming a pure captive, a trade group forming an association captive, and a sponsor forming a protected cell captive. It also covers industrial insured captives, risk retention groups, agency captives, and special purpose financial captives.

The form solves a real problem. Without an approved Certificate of Authority, a captive cannot legally collect premium or pay claims, and any “insurance” it tries to sell is void. Filing wrong does not just slow you down; it can trigger a request for more information, an extra actuarial review at your cost, or a flat denial that forces you to start over.

Each captive type carries its own minimum capital under Tenn. Code Ann. § 56-13-105. A pure captive needs at least $250,000, an association or industrial insured captive needs $500,000, a risk retention group needs $1,000,000, a protected cell captive needs $100,000, and an agency captive needs $250,000. The Commissioner may demand more based on the type, volume, and nature of the risk you plan to insure, so these numbers are floors, not targets.

Before You Start: Documents and Information You Need

Captive applications fail more often from missing attachments than from bad answers, so gather everything before you open the form. The Index for Captive Application lists each required item, and TDCI wants every piece submitted as a separate PDF. Build a checklist and tick off each one before you hit send.

Here is the pre-filing checklist with why each item matters:

• Certificate of formation from the Secretary of State. TDCI approves your formation documents first, then you file with the Secretary of State, and a missing certificate means your application is not even ripe for review.
• A complete Plan of Operation (business plan). This is the heart of the file, and a vague plan triggers actuarial questions that stall approval for weeks.
• Five-year pro forma financial projections. The reviewing actuary tests these for solvency, and gaps here are the top reason files get bounced back.
• Biographical affidavits for each officer and director. Tennessee uses its own (TN) Biographical Affidavit for most captives and the NAIC version only for risk retention groups, and using the wrong one delays the background check.
• Captive manager designation and agreement. TDCI wants to see who runs the captive day to day, and an unsigned agreement reads as an incomplete file.
• Actuary and CPA designation forms. These name your feasibility actuary and auditor, and without them the Department cannot route your file for review.
• Proof of capital and surplus. A bank letter, securities certificate, or irrevocable letter of credit shows the money is real, and a promise without proof is not accepted.
• The $675 application fee. This nonrefundable fee is due before approval under Tenn. Code Ann. § 56-4-101, and a file without payment sits in limbo.

You also need core data on hand: the captive’s exact legal name, its principal office address, the names and Social Security numbers of officers and directors, the lines of coverage you plan to write, and your projected first-year premium. Missing any of these forces you to stop mid-form and chase paperwork, which is how clean 30-day files turn into three-month ordeals.

Where to Get the Form and How to Access It

You get the official form from the TDCI Captive Insurance Applications & Forms page. The main file is the “Captive Insurance Company License Application,” and protected cell sponsors also use the separate “Protected Cell Captive Insurance Company Individual Cell Application.” Both are PDF forms, and TDCI notes the license application needs Adobe Reader 9 or higher to open and fill correctly.

The page is a one-stop shelf. Besides the application, it holds the Index for Captive Application, both biographical affidavits, the irrevocable letter of credit template, the securities account control agreements, and the actuary, captive manager, and CPA designation forms. Download every form that fits your captive type at once so you are not hunting for documents later.

Tennessee strongly favors a pre-filing meeting. The How to Form a Captive page tells you to call or email the Captive Insurance Section first to talk through your idea and get early feedback. This call is free, it is expected, and skipping it is a quiet signal to the Department that the applicant is inexperienced.

Open the PDF on a desktop, not a phone. The form has fields that only render in a full Adobe Reader, and a browser preview can hide boxes or drop your entries. Save a working copy under a clear file name, fill it on screen, and keep a blank master in case you need to start a section over.

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

This is the spine of the application. Work through it in the order the form presents, and remember that TDCI wants each section as its own clean PDF when you submit. Use the exact field labels printed on the form, not your own shorthand.

1. Captive Insurance Company Name

The form first asks for the full legal name of the captive you are forming. Write the name exactly as it appears on the certificate of formation you filed with the Secretary of State, including the word “Insurance” or “Company” if it is part of the registered name. For example, Volunteer Manufacturing Captive Insurance Company gets entered in full, with no abbreviation.

A nuance trips up groups that reserve a name but later tweak it. If your Secretary of State filing reads Volunteer Mfg. Captive Ins. Co. but you type the spelled-out version here, the names will not match and TDCI will pause the file. The most common mistake is entering a “doing business as” name instead of the chartered legal name, which breaks the link between your application and your state charter and forces a correction. A frequent misconception is that the captive name can be finalized later; in truth, the Department approves the name during formation, so it must be locked before this box is filled.

2. Type of Captive Insurance Company

This field asks you to identify which kind of captive you are forming. Check the single box that matches your structure: pure, association, industrial insured, risk retention group, protected cell, agency, or special purpose financial captive. A manufacturer insuring only its own risks marks Pure Captive.

The choice drives your minimum capital, so it is not a casual checkbox. Under § 56-13-105, a pure captive needs $250,000 while a risk retention group needs $1,000,000, and picking the wrong type sets the wrong capital test for your whole file. The common mistake is calling a multi-owner arrangement a “pure” captive when more than one unrelated business shares the risk, which actually makes it an association captive with a higher capital floor. Many filers wrongly believe the type can be switched freely after licensing, but a change of structure is a material change that needs fresh Commissioner approval and a new fee.

3. Principal Office and Place of Business

Here the form asks for the captive’s principal office address in Tennessee. Enter the full street address, city, and ZIP code where the captive’s books and records will be kept, often the office of your captive manager. For instance, a captive managed in Nashville might list 315 Deaderick Street, Nashville, TN 37243.

Tennessee captives must keep a real presence in the state, so a pure mailbox can raise questions. If your captive manager’s office serves as the principal office, name that office and be ready to show the management agreement that ties you to it. The common mistake is listing the parent company’s out-of-state headquarters as the principal office, which conflicts with the in-state requirement and prompts a follow-up letter. A misconception is that a P.O. Box alone satisfies this field; the Department wants a physical location where records live, not just a mail drop.

4. Registered Agent for Service of Process

This field names the person or company authorized to receive legal papers for the captive in Tennessee. Enter the registered agent’s full name and Tennessee street address exactly as filed with the Secretary of State. A captive might list its captive management firm, such as Hamilton Captive Management, LLC, 200 Commerce Street, Nashville, TN 37201.

Risk retention groups have an extra step and must also file the NAIC Service of Process form, so check your type before you move on. The common mistake is naming an agent who has not agreed to serve or who lacks a Tennessee address, which makes the appointment invalid and the box useless. People often think the registered agent and the captive manager must be the same; they can be, but they are separate roles, and the form treats them separately.

5. Officers and Directors

The form asks you to list every officer and director of the captive. Provide each person’s full legal name, title, and business address, and pair the list with a completed biographical affidavit for each individual. A typical entry reads Sarah Whitfield, President, 100 Peabody Place, Memphis, TN 38103.

Each named person must submit the correct affidavit, the (TN) Biographical Affidavit for most captives and the NAIC version only for risk retention groups. The Department runs background checks against these names, so a misspelled name or a missing affidavit halts the review. The common mistake is listing officers but forgetting an affidavit for an outside director, which leaves a hole the actuary and staff cannot clear. A misconception is that affidavits are a formality; in fact, an undisclosed regulatory or criminal issue surfaced here can sink an otherwise strong application.

6. Plan of Operation (Business Plan)

This is the largest and most important part of the form, asking for a full description of how the captive will run. Describe the lines of coverage, the policyholders, the premium volume, the reinsurance you will buy, your underwriting approach, and your investment policy. A pure captive might write that it will insure general liability and property risk for its single parent, writing roughly $1.2 million in first-year premium with $500,000 of excess reinsurance above a $250,000 retention.

The Plan of Operation is what the reviewing actuary tests, so detail wins. Under Tenn. Code Ann. § 56-13-118, any later material change to this plan needs Commissioner approval and a $400 fee, so write it carefully the first time. The common mistake is a thin plan that lists coverages without premium math or reinsurance terms, which forces the actuary to send questions and adds weeks. A frequent misconception is that the plan can stay flexible and vague to allow room to grow; in reality, a vague plan reads as an unready captive and draws more scrutiny, not less.

7. Pro Forma Financial Projections

The form requires financial projections, usually five years out. Provide projected balance sheets, income statements, and loss reserves that flow directly from the premium and loss numbers in your Plan of Operation. For example, your year-one statement should show the $250,000 minimum capital plus projected $1.2 million premium and matching loss reserves.

These projections must tie to your plan; if your plan says $1.2 million in premium but your pro forma shows $800,000, the mismatch flags instantly. The reviewing actuary stress-tests these numbers for solvency, and weak or inconsistent figures are the leading reason files bounce. The common mistake is copying a template without matching it to your own premium and loss assumptions, which produces numbers the actuary cannot reconcile. People often think rough estimates are fine at the application stage, but the Department treats the pro forma as a solvency promise, not a sketch.

8. Capital and Surplus

This field asks how you will meet the minimum capital and surplus for your captive type. State the amount and the form it takes, which must be cash, a cash equivalent, marketable securities, or an irrevocable letter of credit from a bank the Commissioner approves under § 56-13-105. A pure captive shows $250,000 held in cash and approved marketable securities.

If you use securities, you must file a certificate from the official holding them confirming the value and that the deposit protects policyholders and creditors. The common mistake is pledging the bare minimum when the risk volume clearly calls for more, since the Commissioner can require additional capital and a low cushion invites that demand. A misconception is that a parent guarantee counts as capital; it does not, and only the specific approved forms in the statute satisfy this field.

9. Service Provider Designations

Here the form ties in your captive manager, actuary, and certified public accountant. Submit the Captive Manager Designation, Actuary Designation, and CPA Designation forms naming each provider, and make sure the names match the agreements in your file. A captive might name Hamilton Captive Management as manager and a credentialed FCAS actuary for its feasibility study.

The Department wants qualified, named professionals behind every captive, so blank or generic entries draw questions. The common mistake is leaving the actuary box empty because the feasibility study is “almost done,” which stops the file from being routed for review. People often think the captive owner can self-manage without naming a manager; Tennessee expects a designated, experienced manager, and skipping this reads as a red flag.

10. Signature and Certification

The final block is the signature and certification, where an authorized officer swears the application is true and complete. Sign with the officer’s full legal name, print the title, and date it in MM/DD/YYYY format, such as Sarah Whitfield, President, 06/02/2026. An unsigned application is not a filing at all.

The signer takes on personal responsibility for the truth of everything in the file, so the person signing should actually know the contents. The common mistake is a captive manager signing where an officer must sign, which makes the certification defective. A misconception is that an electronic typed name is never enough; TDCI accepts the application submitted electronically as PDFs, but the signature block must be properly executed by an authorized officer.

Three Filled-Out Examples Using Real Scenarios

Below are three common captive scenarios, each followed start to finish. These show how the same form looks for different structures and goals.

Scenario 1: Marcus forms a pure captive for his manufacturing company.

Form Section	What Marcus Enters
Captive Name	Volunteer Manufacturing Captive Insurance Company
Type of Captive	Pure Captive (single parent)
Principal Office	315 Deaderick Street, Nashville, TN 37243
Registered Agent	Hamilton Captive Management, LLC, Nashville, TN
Officers/Directors	Marcus Reed, President; plus two directors with TN affidavits
Plan of Operation	General liability and property for the parent, $1.2M premium
Capital and Surplus	$250,000 in cash and approved securities
Service Providers	Named captive manager, FCAS actuary, and CPA
Application Fee	$675 paid before approval

Scenario 2: Aisha’s trade group forms an association captive.

Form Section	What Aisha Enters
Captive Name	Tennessee Growers Association Captive Insurance Company
Type of Captive	Association Captive
Principal Office	200 Commerce Street, Nashville, TN 37201
Registered Agent	Designated captive manager with TN address
Officers/Directors	Aisha Bennett, Chair; five member-elected directors
Plan of Operation	Workers’ comp and liability for member businesses, $4M premium
Capital and Surplus	$500,000 minimum for an association captive
Service Providers	Named manager, actuary, and CPA designations
Application Fee	$675 plus $440 issuance fee at license

Scenario 3: Janet’s insurer sponsors a protected cell captive.

Form Section	What Janet Enters
Captive Name	Cumberland Protected Cell Captive Insurance Company
Type of Captive	Protected Cell Captive (with cell application)
Principal Office	100 Peabody Place, Memphis, TN 38103
Registered Agent	Sponsor’s TN registered agent
Officers/Directors	Janet Cole, President; sponsor-appointed directors
Plan of Operation	Segregated cells for unrelated participants, per-cell limits
Capital and Surplus	$100,000 core minimum for a protected cell captive
Service Providers	Manager, actuary, and CPA named for the core
Individual Cell Form	Separate cell application filed for each cell

How to File the Completed Form

Tennessee handles captive applications electronically. Submit your completed forms as separate PDF documents to the Captive Insurance Section at captive.insurance@tn.gov, following the order in the Index for Captive Application. The Department asks for each piece as its own clean PDF, not one merged file, so name each document clearly.

The fees are fixed by Tenn. Code Ann. § 56-4-101. You pay a $675 nonrefundable application fee before the captive or cell is approved, and a $440 Certificate of Authority issuance fee once the Department approves you. Later you will face a $515 annual statement filing fee, a $400 fee for any material change to your business plan, and a $7 certificate of compliance fee when needed. If your file is sent to an outside actuarial firm, you also pay that firm’s review cost.

Before any of this, complete the formation steps. You submit formation documents to the Department for the Commissioner’s approval, then file them with the Tennessee Secretary of State with the approval letter and fees, then obtain the formation certification to include with your application. Skipping the order is the fastest way to have your application set aside.

Keep proof of everything. Save the sent email with timestamps, keep payment confirmations for each fee, and retain a dated copy of every PDF you submitted. If the Department asks what you sent and when, your own records are your best defense, and they help you track the roughly 30-day review clock.

What Happens After You File

Once your package lands, the Captive Insurance Section reviews it for completeness and routes the file to the Department’s reviewing actuary. The actuary tests your Plan of Operation and pro forma financials for solvency, and may send written questions if anything is unclear or inconsistent. A clean, complete file moves through this stage in about 30 days.

The actuary’s report goes back to the Captive Insurance Section, which folds it into a recommendation to the Commissioner. If the Commissioner approves, the Department issues your Certificate of Authority, and you pay the $440 issuance fee at that point. Only after the certificate issues can your captive legally write policies and collect premium.

Approval is the start of ongoing duties, not the end. After licensing, TDCI requests executed agreements with your manager, auditor, and actuary, copies of policies issued, board minutes, your investment policy, and a conflict of interest policy. These oversight documents keep your captive in good standing year after year.

You also pick up annual obligations. Your captive files an annual statement, generally by March 15 for most captives and March 1 for risk retention groups, pays the $515 statement fee, and pays premium tax under the captive tax rules. Miss these and your good standing, and even your license, can be at risk.

Mistakes to Avoid When Filling Out the Form

Captive applications have many moving parts, and small errors carry real cost. Watch for these:

• Skipping the pre-filing call. You lose the Department’s early feedback and walk into review blind.
• Filing out of order. Applying before Secretary of State formation makes your file premature and sets it aside.
• Picking the wrong captive type. It sets the wrong capital minimum and can void your whole capital plan.
• Merging everything into one PDF. TDCI wants separate PDFs, and a single blob slows the review.
• A thin Plan of Operation. It triggers actuary questions that add weeks to your timeline.
• Pro forma that does not match the plan. Inconsistent numbers are the top reason files bounce back.
• Using the wrong biographical affidavit. The NAIC form is only for risk retention groups, and the mix-up delays background checks.
• Forgetting an affidavit for a director. A missing affidavit leaves a hole staff cannot clear.
• Pledging only the bare minimum capital. It invites the Commissioner to demand more and signals weakness.
• Treating capital proof as optional. A promise without a bank letter or securities certificate is not accepted.
• Leaving the actuary designation blank. The file cannot be routed for review without a named actuary.
• Wrong person signing the certification. A manager signing where an officer must sign makes it defective.

Do’s and Don’ts

Do:

• Do call the Captive Insurance Section first, because early feedback steers you away from costly missteps.
• Do submit each document as a separate PDF, since that is how TDCI organizes the review.
• Do match your pro forma to your plan, because the actuary checks the two against each other.
• Do use the exact legal name from your charter, so your application links cleanly to your state filing.
• Do keep proof of every filing and fee, because your records protect you if a question arises.
• Do budget for the full fee stack, since the $675 and $440 are only the start.

Don’t:

• Don’t file before Secretary of State formation, because the application is not ripe without it.
• Don’t guess your captive type, since the wrong choice breaks your capital math.
• Don’t write a vague Plan of Operation, because vagueness reads as an unready captive.
• Don’t use the NAIC affidavit for a non-RRG captive, as it is the wrong form and delays review.
• Don’t pledge only the minimum capital blindly, because thin cushions draw extra capital demands.
• Don’t let a non-officer sign the certification, since that makes the filing defective.

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

Most Tennessee captives use a professional captive manager, but some sophisticated parents handle more in-house. Here is the trade-off.

Pros of using a captive manager:

• Faster approvals, because experienced managers know exactly what TDCI expects.
• Stronger Plan of Operation, since managers draft these for a living.
• Cleaner actuarial coordination, because they work with feasibility actuaries often.
• Fewer rejections, as they catch missing affidavits and mismatched numbers early.
• Ongoing compliance help, since they handle annual statements and oversight filings.

Cons of using a captive manager:

• Added cost, because management fees stack on top of state fees.
• Less direct control, since a third party runs day-to-day filings.
• Dependence on one firm, which can complicate a later switch.
• Information lag, because you learn of issues through the manager.
• Still your responsibility, as the captive owner signs and owns the outcome regardless.

Key Entities That Interact With This Form

Several players touch a Tennessee captive application. The TDCI Captive Insurance Section reviews and oversees the captive, the Commissioner grants the Certificate of Authority, and the Tennessee Secretary of State charters the company before licensing. The Department’s reviewing actuary tests solvency, and the Revised Tennessee Captive Insurance Act supplies the rules these offices enforce.

FAQs

Do I file with the Secretary of State or TDCI first?

No to filing the application first. You get Commissioner approval of formation documents, then file with the Secretary of State, then submit your application to TDCI with the formation certificate.

Is the $675 application fee refundable if I am denied?

No. The application fee under Tenn. Code Ann. § 56-4-101 is nonrefundable, so you do not get it back even if the Commissioner denies your captive.

Do I mark “Pure Captive” if two unrelated companies share the risk?

No. Two unrelated owners sharing risk makes it an association captive, which carries a $500,000 minimum instead of the $250,000 pure captive floor.

Can I write a vague Plan of Operation to stay flexible?

No. A vague plan triggers actuary questions and delays approval, and any later material change needs Commissioner approval plus a $400 fee.

Do I use the NAIC biographical affidavit for a pure captive?

No. The NAIC affidavit is only for risk retention groups; pure and most other captives use the Tennessee biographical affidavit.

Is $250,000 always enough capital for a pure captive?

No. It is the legal minimum, but the Commissioner may require more based on the type, volume, and nature of the risk you plan to insure.

Can a parent company guarantee count as my capital?

No. Only cash, cash equivalents, approved marketable securities, or an approved irrevocable letter of credit satisfy the capital requirement under § 56-13-105.

Do I submit all documents as one merged PDF?

No. TDCI asks for each document as a separate PDF submitted to captive.insurance@tn.gov, in the order of the Index for Captive Application.

Can my captive manager sign the certification block?

No. An authorized officer must sign and certify the application, since that person takes personal responsibility for its truth.

Is a P.O. Box enough for the principal office field?

No. The Department wants a physical Tennessee location where the captive’s books and records live, not just a mail drop.

Can I write policies as soon as I file the application?

No. You may only transact insurance after the Commissioner issues your Certificate of Authority and you pay the $440 issuance fee.

Do I need an actuary named before I submit?

Yes. You must file an Actuary Designation naming your feasibility actuary, because the file cannot be routed for actuarial review without one.

Is the review really done in about 30 days?

Yes, when the file is clean and complete; missing documents or a weak Plan of Operation can stretch the timeline well beyond a month.

Do protected cell captives file an extra form?

Yes. A protected cell sponsor files the separate Protected Cell Captive Insurance Company Individual Cell Application for each cell, on top of the core license application.