(f) Complete and enclose the form entitled Appointment of Attorney to Accept Service of
Process, available on the web as follows:
If the applicant selected ‘Captive Risk Retention Group’ in #5, use the form located at:
If the applicant selected any choice except ‘Captive Risk Retention Group’ in #5, use
the form located at:
(g) If the applicant selected Corporation in #6, then include draft articles of incorporation
and draft bylaws.
(h)If the applicant selected LLC in #6, then include draft articles of organization and a draft
(i) If the applicant selected Partnership or Limited Partnership or LLP in #6, then include
the registration, certificate, or any other relevant organizational documents.
(j) If the applicant selected Reciprocal in #7, then include a certified copy of the power of
attorney-in-fact and subscriber’s agreement.
(k)For each captive owner shown in #11, include a current financial report for the owner.
(l) If #13 indicates that a Letter of Credit will be used, the State of Montana’s approved
Irrevocable Letter of Credit form must be used (attached).
(m)For the Captive Manager shown in #14, Claims Handler shown in #15, and MGA/MGU
shown in #16, include an unexecuted (draft) contract between the captive and each of
these service providers.
(n)For the service providers shown in #’s 14-20, list each service provider’s responsibilities
together with how fees for services rendered are to be charged.
(o)For the CPA shown in #18, include a completed Application for Authorization as an
Independent Certified Public Accountant for Captive Insurance Business. The
form is attached. (Note: this item can be skipped if the CPA is already approved by the
State of Montana).
(p)For the Actuary shown in #19, include a completed Application for Authorization to
Certify Loss Reserves and Loss Expense Reserves for Captives. The form is
attached. (Note: this item can be skipped if the Actuary is already approved by the State
(q)A biographical affidavit for each individual listed in #21 (form attached).
(r) Detailed Plan of Operation with supporting data including:
(1) Risks to be insured – direct, assumed and ceded – by line of business.
(2) Name of fronting company, if operating as a reinsurer.
(3) Five-year projection of expected gross and net annual premium income by line of