Captive Insurer Annual Report


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.