ADOI Fee Schedule

NEW AGENCY


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).


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

Priority: 
400
sort descending
Amended Certificate of Authority - Line of Business Change
Captive Division Facts and Statistics
Captive Insurer (Non-RRG) Reference Guide
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.

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
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.
Preparing the Management Discussion and Analysis Report
Risk Retention Group Captive Reference Guide