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NEW ADDRESS


Arizona Department of Insurance
100 North 15th Avenue, Suite 261

Phoenix, AZ  85007-2630

Starting July 1, 2020, we will be the
Department of Insurance and Financial Institutions (DIFI).


NOTICE

Arizona state agencies are experiencing telephone system problems that may impact your ability to reach us.  If you can e-mail us instead (see our CONTACT US page), please do so.  We do not have an estimate time by which the problem will be resolved.  We are very sorry for any inconvenience this is causing.


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Titlesort descending Last updated Attachments
Calendar of Upcoming Hearings 05/03/2020 (Mon)
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PDF icon 03.16.2020 (2).pdf4.99 KB
Canceling a Health Insurance Marketplace Policy 03/02/2018 (Fri)
Captive Division Facts and Statistics 08/03/2020 (Tue)
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PDF icon Captive Division Facts and Stats 20200302.pdf399.17 KB
Captive Insurer 05/01/2020 (Fri)
Captive Insurer (Non-RRG) Reference Guide 10/02/2019 (Mon)
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PDF icon CaptiveRefGuide_NonRRG_Feb2019.pdf649.45 KB
Captive Insurer Annual Filing Portal Instructions 02/10/2018 (Mon)
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PDF icon Captive Insurer Annual Statement Portal Instructions 20160226.pdf109.77 KB
Captive Insurer Annual Report 02/10/2018 (Mon)
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File Captive Insurer Annual Report209.5 KB
Captive Insurer Annual Report and Renewal Fee Transmittal 08/11/2014 (Fri)
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PDF icon Captive_109_Annual_Renewal_Fee2014.pdf79.26 KB
Captive Insurer Audited Financial Report Exemption Standards and Filing Requirements 08/11/2014 (Fri)
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PDF icon Captive_304.pdf50.82 KB
Captive Insurer Biographical Affidavit 10/12/2014 (Tue)
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PDF icon Captive_101A_Bio_Affidavit_v2.pdf22.18 KB
Captive Insurer Certificate of Authority Application: Use this form to apply for a domestic captive or captive risk retention group insurer license. 08/03/2020 (Tue)
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PDF icon CID-APP_03 2020.pdf203.42 KB
Captive Insurer Certificate of Disclosure 08/12/2014 (Wed)
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PDF icon e-178CertofDiscloser.pdf440.76 KB
Captive Insurer Conflict of Interest - Directors and Officers 10/10/2018 (Mon)
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PDF icon CID Form_COI_10 2018.pdf126.38 KB
Captive Insurer Irrevocable Letter of Credit - Sample Form 09/10/2018 (Mon)
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PDF icon Form CID-LOC (10 2018).pdf128.4 KB
Captive Insurer Management Firm Profile 09/10/2018 (Mon)
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PDF icon CID_Mgmt Firm Profile 10 2018.pdf117.96 KB
Captive Insurer Protected Cell Supplemental Application 09/03/2020 (Tue)
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PDF icon CID-Cell Supplement (03 2020) Fillable.pdf1.5 MB
Captive Insurer Quarterly and Annual Statement Filings for Risk Retention Group - NAIC Note 1 08/11/2014 (Fri)
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PDF icon Communication_for_Note_1_Disclosure.pdf26.64 KB
Captive Insurer Reinsurance Structure 09/10/2018 (Mon)
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PDF icon CID_Reins Structure (10 2018).pdf178.49 KB
Certified Application Counselor 07/01/2015 (Fri)
CERTIFIED APPLICATION COUNSELOR: Continuing Education 10/09/2014 (Wed)
CERTIFIED APPLICATION COUNSELOR: License Application 08/11/2014 (Tue)
CERTIFIED APPLICATION COUNSELOR: License Compliance 04/11/2014 (Fri)
CERTIFIED APPLICATION COUNSELOR: License Renewal 06/09/2014 (Tue)
Choosing a Medigap Policy: A guide to Health Insurance for People with Medicare 01/08/2019 (Wed)
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PDF icon 02110-medicare-medigap-guide.pdf856.39 KB
Circular Letter 1981-02 11/12/2014 (Sat)
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PDF icon 81-02.pdf13.14 KB
Circular Letter 1981-03 10/12/2014 (Sat)
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PDF icon 81-03.pdf15.05 KB
Circular Letter 1985-02 10/12/2014 (Sat)
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PDF icon 85-02.pdf10.24 KB
Circular Letter 1987-06 10/12/2014 (Sat)
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PDF icon 87-06.pdf12.31 KB
Circular Letter 1988-01 10/12/2014 (Sat)
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PDF icon 88-01.pdf11.42 KB
Circular Letter 1989-02 10/12/2014 (Sat)
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PDF icon 89-02.pdf12.23 KB
Circular Letter 1990-01A 10/12/2014 (Sat)
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PDF icon 90-01A.pdf14.4 KB
Circular Letter 1990-04A 10/12/2014 (Sat)
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PDF icon 90-04A.pdf18.52 KB
Circular Letter 1990-05A 10/12/2014 (Sat)
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PDF icon 90-05A.pdf12.39 KB
Circular Letter 1990-07A 10/12/2014 (Sat)
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PDF icon 90-0A.pdf12.81 KB
Circular Letter 1992-01 10/12/2014 (Sat)
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PDF icon 92-01.pdf11.24 KB
Circular Letter 1992-03 10/12/2014 (Sat)
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PDF icon 92-03.pdf11.7 KB

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