Office of the Lieutenant Governor, VI · St. Thomas
Original Insurance Application for Residents or Non-Residents (Individual)
Individuals seeking an original U.S. Virgin Islands insurance license use this application to provide licensing, personal, work history, and background information.
What this form is
This application is for individuals applying for an original resident or non-resident insurance license, and it requires a separate application for each license type. It asks for identifying and contact details, license category, affiliations, license and residence history, employment, and background disclosures. The form also lists supporting documents and licensing items that may be needed, with fees and bond requirements varying by license type and applicant.
Who needs it
Individuals applying for an original resident or non-resident insurance license in the U.S. Virgin Islands should complete this application.
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 does not require a notary; the applicant certifies the information under penalty of perjury and signs and dates the application.
How to submit this form
- 1
Download The Application
Download the original individual insurance application PDF.
- 2
Complete The Application
Select the license type and provide the requested personal, licensing, work history, and background information.
- 3
Gather Supporting Items
Review the form’s checklist and your answers for required identification, bonds, supporting documents, and fees applicable to your license type.
- 4
Submit To The Division
Use the Division addresses listed on the form. Make checks or money orders payable to Government of the U.S. Virgin Islands.
Frequently asked questions
- Who uses the Original Insurance Application for Residents or Non-Residents?
- Individuals applying for an original resident or non-resident insurance license use this application. The form says to complete a separate application for each license type.
- Do I need a notary for the Original Insurance Application?
- No. This application does not require a notary. The applicant certifies the information under penalty of perjury and signs and dates the application.
- How do I submit the Original Insurance Application?
- The form lists the Division of Banking, Insurance and Financial Regulation addresses in St. Thomas and Christiansted. It also says checks and money orders must be payable to Government of the U.S. Virgin Islands.
Need something notarized?
This Original Insurance Application for Residents or Non-Residents (Individual) doesn’t need a notary — but if you have another Office of the Lieutenant Governor form that does, a commissioned online notary can help.