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FIS 2212 (11/25) Department of Insurance and Financial Services Page 1 of 7Captive Insurer Instructions for Application for Limited Certificate of Authority Each applicant for a limited certificate
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How to fill out certificate of authority section

01
Begin by entering the name of the issuing authority responsible for the certificate.
02
Provide the address of the issuing authority, including street, city, state, and ZIP code.
03
Specify the date the certificate is being issued.
04
Include the name of the entity or individual receiving the certificate.
05
Include relevant details such as the nature of the authority granted or the purpose of the certificate.
06
Sign the certificate by the authorized representative of the issuing authority.
07
If applicable, include any official seals or stamps to validate the document.

Who needs certificate of authority section?

01
Businesses seeking to operate legally in certain jurisdictions.
02
Organizations applying for licenses or permits.
03
Individuals requiring proof of legal authority to act on behalf of a company.
04
Entities pursuing funding or financial support from investors or institutions.
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The certificate of authority section is a legal document that grants a business entity the right to operate within a specific jurisdiction. It typically indicates that the entity has met all necessary compliance and regulatory requirements to do business in that area.
Business entities, such as corporations and limited liability companies (LLCs), that wish to conduct business in a state or locality outside of their formation state are typically required to file a certificate of authority.
To fill out the certificate of authority section, provide information such as the entity's name, the state of incorporation, the date of incorporation, the business address, and the name and address of the registered agent for service of process.
The purpose of the certificate of authority section is to ensure that out-of-state businesses comply with local laws and regulations, thereby protecting the interests of consumers and the state.
The information that must be reported includes the legal name of the business, the state where it was formed, the nature of the business, the principal office address, and the name and address of the registered agent.
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