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NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES CAPTIVE INSURANCE COMPANY BIOGRAPHICAL AFFIDAVIT Full Name and Address of Captive Insurance Company: In connection with the above named company, I herewith
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How to fill out ny captive biographical affidavit:

01
Gather all necessary information about yourself, including personal details such as name, address, date of birth, and contact information.
02
Fill in the section that asks for your educational background, including any degrees or certifications you hold.
03
Provide a detailed employment history, including the names of previous employers, dates of employment, and job titles held.
04
Include any relevant professional licenses or designations you possess.
05
Disclose any past criminal convictions or disciplinary actions taken against you, if applicable.
06
Sign and date the affidavit, certifying that all the information provided is true and accurate to the best of your knowledge.

Who needs ny captive biographical affidavit:

01
Individuals who are applying for a captive insurance license in the state of New York.
02
Captive insurance companies operating in New York that are required by law to submit biographical affidavits for their key personnel.
03
Insurance regulators and licensing authorities who use the biographical affidavits to assess the suitability and integrity of individuals involved in captive insurance operations.
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The NY Captive Biographical Affidavit is a document that collects biographical information about individuals associated with a captive insurance company.
Anyone who is an officer, director, or key employee of a captive insurance company in New York is required to file the NY Captive Biographical Affidavit.
To fill out the NY Captive Biographical Affidavit, individuals must provide their personal information such as name, address, contact details, employment history, and any criminal or regulatory actions taken against them.
The purpose of the NY Captive Biographical Affidavit is to ensure that individuals associated with captive insurance companies in New York are fit and qualified for their roles, and to provide transparency to regulatory authorities.
The NY Captive Biographical Affidavit requires individuals to report their personal information, employment history, criminal or regulatory actions, and any other relevant information as requested in the form.
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Related Links

State of Delaware - Captive Insurance - Authorized Service Providers
The business entities authorized in Delaware to serve captive insurance companies. ... Form B-1 Biographical Affidavit; Form E-1 Actuarial Authorization Application; Form E-2 Captive Manager ..... Captive Planning Associates of New York.
biographical affidavit - CT.gov
3 Nov 2015 ... PHL Variable Insurance Company, Phoenix Life and Annuity Company, American .... ADMITTED TO THE BAR OF THE STATE OF NEW YORK.
Captive Insurance Regulation - CT.gov
This office is currently closed to public visitors as a protective measure for the safety of customers and staff. The department will continue to provide services by  ...

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