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| Home > Insurance Division > Captive Insurance > Registered Service Providers |
| Registered Service Providers |
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| Business entities currently registered in New Jersey to service captive insurance companies: |
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| Interested in becoming a New Jersey registered service provider? Submit an application to:
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Office of Captive Insurance
NJ Department of Banking and Insurance
20 W. State St.
PO Box 325
Trenton, NJ 08625-0325
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| E-mail: dobi.captives@dobi.nj.gov |
| Telephone: 609-292-7272 |
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| Forms |
| Note: 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 where indicated. |
Office of Captive Insurance
NJ Department of Banking and Insurance
20 W. State St.
PO Box 325
Trenton, NJ 08625-0325 |
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| Actuaries/Actuarial Firms: Application and Biographical Affidavit |
| Captive Managers: Application and Biographical Affidavit |
| Certified Public Accountants: Application and Biographical Affidavit |
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