Arizona Department of Insurance
100 North 15th Avenue, Suite 261
Phoenix, AZ 85007-2630
Starting July 1, 2020, we became 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.