***Notice Regarding the Statutory Requirement for Holding Board Meetings in the State***
06/04/2021: For board members and other AZ captive representatives who want to mitigate the risk of air travel and continue to adhere to social distancing recommendations to reduce the spread of COVID-19, note the following: The ARS 20-1098.01(E)(1) requirement that a captive insurer’s board of directors or subscriber's advisory committee meet at least once each year in this state may be accomplished through the use of a telephonic meeting with the Arizona resident director in attendance. Absent adverse developments causing a reevaluation, this advisory will expire after December 2021.
01/20/2021: Based upon the CDC’s recommendations related to the risk of air travel and the need for social distancing to reduce the spread of COVID-19, the ARS 20-1098.01(E)(1) requirement that a captive insurer’s board of directors or subscriber's advisory committee meet at least once each year in this state may be accomplished through the use of a telephonic meeting with the Arizona resident Director in attendance. The need for this advisory will continue to be evaluated for periods beyond August 2021 as conditions warrant.
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.
| 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. |
| 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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| 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. |
| 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. |
| Form E-178: Certificate of Disclosure | |
| Insurance Fee Schedule |
Fees are nonrefundable upon payment. ARS § 20-167(A) |
| CREDIT PROPERTY EXPERIENCE REPORT, ANNUAL STATEMENT SUPPLEMENT | |
| CREDIT LIFE, DISABILITY AND UNEMPLOYMENT EXPERIENCE REPORT |