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.
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 submit most filings directly to the NAIC but will use the Portal to file the signed Jurat page for the annual and quarterly blanks, 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.
| CREDIT LIFE, DISABILITY AND UNEMPLOYMENT EXPERIENCE REPORT | |
| CREDIT PROPERTY EXPERIENCE REPORT, ANNUAL STATEMENT SUPPLEMENT | |
| For Risk Retention Groups: Captive Insurer Annual Report and Renewal Fee Transmittal | 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.
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| 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. |
| 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. |
| Insurance Fee Schedule | Fees are nonrefundable upon payment. ARS § 20-167(A) |
| Captive Insurer Annual Report | Complete this form as part of the required annual filing for insurers licensed as (non-RRG) captives, unless instructed by the Department to use a different format. RRGs file using the NAIC Blank. |
| Form E-178: Certificate of Disclosure | |
| Preparing the Management Discussion and Analysis Report |