Arizona Department of Insurance and Financial Institutions (DIFI)

DIFI Contact Information

100 N. 15th Avenue, Suite 261

Phoenix, Arizona 85007-2630

Governor: Katie Hobbs

Interim Director: Maria Ailor

Chief Captive Analyst: Victoria Fimea

Phone: 602.364.4490

Website

Captive Filing Forms

• Captive Insurance Program Frequently Asked Questions
• Captive Insurer Certificate of Authority Application
  
• Preparing the Management Discussion and Analysis Report
  
• Captive Insurer Reinsurance Structure
  
• Captive Insurer Protected Cell Supplemental Application
  
• Captive Insurer Biographical Affidavit
  
• Captive Insurer Management Firm Profile
  
• Captive Insurer Irrevocable Letter of Credit - Sample Form
• Captive Insurer Conflict of Interest - Directors and Officers
• Amended Certificate of Authority - Line of Business Change
• Insurance Fee Schedule