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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).

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Titlesort ascending Last updated Attachments
CERTIFIED APPLICATION COUNSELOR: Continuing Education 10/09/2014 (Wed)
Certified Application Counselor 07/01/2015 (Fri)
Captive Insurer Reinsurance Structure 09/10/2018 (Mon)
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PDF icon CID_Reins Structure (10 2018).pdf178.49 KB
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 Protected Cell Supplemental Application 08/09/2019 (Tue)
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PDF icon CID-Cell Supplement (07 2019) Fillable.pdf1.48 MB
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 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 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 Certificate of Disclosure 08/12/2014 (Wed)
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PDF icon e-178CertofDiscloser.pdf440.76 KB
Captive Insurer Certificate of Authority Application: Use this form to apply for a domestic captive or captive risk retention group insurer license. 03/09/2019 (Thu)
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PDF icon CID-APP_10 2019.pdf199.08 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 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 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 Annual Report 02/10/2018 (Mon)
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File Captive Insurer Annual Report209.5 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 (Non-RRG) Reference Guide 10/02/2019 (Mon)
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PDF icon CaptiveRefGuide_NonRRG_Feb2019.pdf649.45 KB
Captive Insurer 05/01/2020 (Fri)
Captive Division Facts and Statistics 12/01/2020 (Mon)
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PDF icon Captive Division Facts and Stats 20200106.pdf391.07 KB
Canceling a Health Insurance Marketplace Policy 03/02/2018 (Fri)
Calendar of Upcoming Hearings 11/02/2020 (Fri)
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PDF icon 02.14.2020.pdf5.24 KB

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