Arizona Department of Insurance
100 North 15th Avenue, Suite 261Phoenix, AZ 85007-2630
Starting July 1, 2020, we will be the
Department of Insurance and Financial Institutions (DIFI).
Complete this form as part of the required annual filing for insurers licensed as (non-RRG) captives, unless instructed by the Department to use a different format. RRGs file using the NAIC Blank.