Form C-203 Direct Economic Impact Service Provider

*2024 UPDATE:  Now in EXCEL (.xlsx) Format.  Please use the EXCEL file linked above to complete and submit Form C-203.

The NCDOI requests each captive insurance service provider conducting business in North Carolina submit a completed C-203 report by March 1st of each year.  Please note that only one form is required per service provider, which contains a report of all revenues earned by North Carolina office(s) of the provider and all expenses paid by the providers to persons located in North Carolina. A form is not required for each captive insurer.