For Risk Retention Groups: Captive Insurer Annual Report and Renewal Fee Transmittal


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).

This form provides a checklist of captive RRG 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 RRGs will use the Portal to file the annual and quarterly signed Jurat pages, the annual Form E-178, and the actuarial opinion summary, and will continue to file most other documents through the NAIC.