Captive Insurer Annual Report

NEW ADDRESS


Arizona Department of Insurance
100 North 15th Avenue, Suite 261

Phoenix, 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.