Office of the Lieutenant Governor, VI · St. Thomas
Original Insurance Application for Resident or Non-Resident Business Entities
Business entities use this application to seek an original insurance license as a resident or non-resident for the license types listed on the form.
What this form is
The application collects the entity’s contact and organization details, requested license types, affiliations, ownership information, and answers to background questions. Applicants select the applicable sections and provide supporting documents where requested, such as organizational documents or explanations for yes answers. The form includes a certification signed by an authorized entity representative and a final page listing licensing items and fees.
Who needs it
A business entity seeking an original resident or non-resident insurance license for one of the license types listed on the application needs this form.
How to submit it
The form lists the Division of Banking, Insurance and Financial Regulation at 5049 Kongens Gade, St. Thomas, and 1131 King Street, Suite 101, Christiansted. It says checks and money orders must be payable to Government of the U.S. Virgin Islands.
About notarization
This application has no notary block; the authorized representative signs and dates its certification, which is made under penalty of perjury.
How to submit this form
- 1
Download The Application
Download the original resident or non-resident business entity insurance application.
- 2
Complete Applicable Sections
Select the license type and complete the relevant business, affiliation, ownership, and background sections.
- 3
Gather Required Attachments
Include applicable organizational documents, bonds, and supporting statements or records requested by the form.
- 4
Sign And Date
Have an authorized officer, director, partner, member, or manager sign and date the certification.
- 5
Submit To The Division
Use the Division addresses printed on the form; checks and money orders must be payable to Government of the U.S. Virgin Islands.
Frequently asked questions
- Do I need a notary for the business entity insurance application?
- No. The form has no notary block; an authorized representative signs and dates the certification, which is made under penalty of perjury.
- How do I submit the original insurance application?
- The form lists the Division of Banking, Insurance and Financial Regulation at 5049 Kongens Gade, St. Thomas, and 1131 King Street, Suite 101, Christiansted.
- What information does the application ask for?
- It asks for the requested license type, business and contact details, licensing history, affiliations, ownership information, and answers to background questions.
- What attachments may be required?
- Depending on the applicant and answers, the form calls for items such as articles of incorporation or organization, partnership agreements, bonds, and supporting documents for certain yes answers.
Need something notarized?
This Original Insurance Application for Resident or Non-Resident Business Entities doesn’t need a notary — but if you have another Office of the Lieutenant Governor form that does, a commissioned online notary can help.