FINANCIAL REPORTING - DOMESTIC: Captive Insurer

Captive News

3/22/2017:  The Captive Annual Filing Portal now accepts captive renewal fee payments by credit card (Visa, MasterCard or Discover) or by ACH electronic check!  Please use the portal to pay your fee.  

3/10/2017: Captive insurers and domestic risk retention groups will soon be able to use a new version of Arizona's secure, encrypted Captive Insurer Annual Filing Portal ("Portal") to pay annual renewal fees with a Visa, MasterCard, Discover, or ACH electronic check.

FOR CAPTIVE ANNUAL FINANCIAL REPORTS DUE ON OR AFTER MARCH 31, 2017, we recommend waiting to file and pay until the earlier of Monday, March 20, or the date the new version of the Portal becomes available.

2/29/2016:  Captive insurers  must use Arizona's new secure, encrypted Captive Insurer Annual Filing Portal ("Portal"), available at https://azinsurance.online/upload/captiveannual, to upload all documents pertaining to the annual filing. 

NOTE: Domestic risk retention groups shall continue to submit filings to the NAIC but will use the Portal to file the actuarial opinion summary and the Certificate of Disclosure (Form E-178). 

Using the Portal is free, easy, secure, and eliminates the hassle of having to send information by mail on CDs/DVDs.

Contact the Captive Insurance Division at (602) 364-4490 if you have any questions about the Portal or filing requirements.

ANNUAL FILINGS

Captive Insurer Annual Report and Renewal Fee Transmittal

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

NOTE: Domestic risk retention groups will only use the Portal to file Form E-178 and the actuarial opinion summary, and will continue to file other documents through the NAIC.

Captive Insurer Annual Report

Complete this form as part of the required annual filing for insurers licensed as (non-RRG) captives.  See the Captive Insurer Annual Report Instructions for more information.

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. This document contains instructions for using the Portal.

Form E-178: Certificate of Disclosure
Department of Insurance Fee Schedule