Custodial Bank Deposit New Account Packet

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).

Includes Form E-003, E-125 and instructions on how to establish an account for applicants who elect to use marketable securities to satisfy a financial security requirement.

Form EXSAPP: Application for Workers' Compensation Deposit Reduction - Instructions
Form E126XS: Application and Order for Release of Excess Deposit
Form E126-CD: Request for Release of Certificate of Deposit
Form E125-CD: Certificate of Deposit Transmittal
Form E126LOC: Request for Release of Letter of Credit
Form E150 - Assignment of Certificate of Deposit or Time Deposit to Arizona State Treasurer
Form E230: Change to Domestic Insurer Statutory Agent
Administrative Order 00A-123-INS: Investment Grade Ratings for and Eligibility of Investments in Obligations and Preferred Stock under A.R.S. §§ 20-544 and 20-545
Form E110: Biographical Affidavit
Captive Insurer Annual Report and Renewal Fee Transmittal
Captive Insurer Audited Financial Report Exemption Standards and Filing Requirements
Captive Insurer Quarterly and Annual Statement Filings for Risk Retention Group - NAIC Note 1
Form E110: Biographical Affidavit
Administrative Order 00A-123-INS: Investment Grade Ratings for and Eligibility of Investments in Obligations and Preferred Stock under A.R.S. §§ 20-544 and 20-545
Credit Property Experience Report, Annual Statement Supplement
Form E125: Security Deposit Form
Form E126: Security Release Form
Form E-857: Bond of Service Company
Form E-800: Application for Service Company Permit

This is the primary application form for a service company permit.  The form and its instructions identify other documents you must submit with this form.  You must complete the form on a computer - do not print it out until it is complete and all requirements are satisfied.

Form E-811: Renewal of Service Company Permit

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