The State of New Jersey
NJ Department of Banking and Insurance

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Captive Insurer Redomestication Admission Packet

Note: Most of the documents below are "fillable" PDFs which can be opened with Adobe Acrobat Reader and filled out directly on the screen. Please print the completed forms and sign as needed. See Redomesticating a Captive in NJ to schedule a meeting with the Department before submitting any application. Captive Insurance
20 W. State St.
PO Box 325
Trenton, NJ 08625-0325

Captive Admission Application

2. Strategic Business Plan
3. Biographical Affidavits
4. Designee for Receipt of Service of Process
5. Designee to Receive Department Documents

In addition, the applicant must also submit the following to the Department with the Redomestication Application Packet:
  Check mark Current Examination Reports
  Check mark Most recent year-end financial statements and any subsequently prepared quarterly statements
  Check mark Last audited financial statement
  Check mark Statement of Good Standing from regulator in current domiciliary jurisdiction
OPRA is a state law that was enacted to give the public greater access to government records maintained by public agencies in New Jersey.
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New Jersey Department of Banking and Insurance