ADOI Fee Schedule

Fees are nonrefundable upon payment.  ARS § 20-167(A)

Priority: 
400
Captive Insurer Biographical Affidavit
Captive Insurer Certificate of Authority Application: Use this form to apply for a domestic captive or captive risk retention group insurer license.
Captive Insurer Conflict of Interest - Directors and Officers
Captive Insurer Irrevocable Letter of Credit - Sample Form
Captive Insurer Management Firm Profile
Captive Insurer Protected Cell Supplemental Application
Captive Insurer Reinsurance Structure
Amended Certificate of Authority - Company Code
Preparing the Management Discussion and Analysis Report
Captive Insurer Annual Filing Portal Instructions

Captive insurers other than domestic risk retention groups must use Arizona's new Captive Insurer Annual Filing Portal ("Portal"), available at https://azinsurance.online/upload/captiveannual, to upload all documents pertaining to the annual filing. RRGs also use the portal on a limited basis.  This document contains instructions for using the Portal.

For Captives Other Than RRGs: Captive Insurer Annual Report and Renewal Fee Transmittal

This form provides a checklist of captive insurer annual filing requirements.  Pay the annual renewal fee via the online portal or mail a check to the Department of Insurance either with this form or a printout of the "Success!" page you receive after uploading Annual Report documents to the Captive Insurer Annual Report Portal. 

NOTE: Domestic captive RRGs have a different checklist.  See Below.

Risk Retention Group Captive Reference Guide
Captive Division Facts and Statistics
Captive Insurer (Non-RRG) Reference Guide
The Risk Retention Reporter: Licensing Quality RRGs is Aim of Arizona Captive Program