Form E-700: Certificate of Surplus Lines Broker

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).

For unauthorized foreign/alien insurer qualification: The surplus lines broker must complete and sign this form and provide this form with other surplus lines insurer sponsorship forms to the Department of Insurance Surplus Lines Team. REPLACES FORM SL-110.

Form SL-112: Application for Domestic Surplus Lines Insurer Designation

An Arizona-authorized domestic insurer uses this application form to apply to be designated as a domestic surplus lines insurer. 

Form E-701: Certificate of Public Supervisory Official

For unauthorized foreign/alien insurer qualification: The public supervisory official from the insurer's domicile must complete this form and return the form to the surplus lines broker. The broker must submit the completed form with other surplus lines insurer sponsorship forms. REPLACES FORM SL-111.