The State of New Jersey
NJ Department of Banking and Insurance

Home > Insurance Division > Captive Insurance > Redomestication Application Packet
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 where indicated. See Redomesticating a Captive to NJ for information about this procedure.
Office of Captive Insurance
New Jersey Department of Banking and Insurance
20 W. State St.
PO Box 325
Trenton, NJ 08625-0325
1. Captive Admission Application
2. 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:
  • Current Examination Reports
  • Most recent year-end financial statements and any subsequently prepared quarterly statements
  • Last audited financial statement
  • 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.
Adobe Acrobat
You will need to download the latest version of Adobe Acrobat Reader in order to correctly view and print PDF (Portable Document Format) files from this web site.
state seal
Copyright © 2021, State of New Jersey
New Jersey Department of Banking and Insurance