Arizona Department of Insurance
100 North 15th Avenue, Suite 261Phoenix, AZ 85007-2630
Fees are nonrefundable upon payment. ARS § 20-167(A)
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.
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.