Arizona Department of Insurance
100 North 15th Avenue, Suite 261
Phoenix, AZ 85007-2630
Starting July 1, 2020, we became the
Department of Insurance and Financial Institutions (DIFI).
For all foreign or alien insurers. Please refer to information provided in the Arizona Retaliation Guide and in the insurer's Taxes and Fees Data Sheet.
You must complete this form if the insurer's domicile requires Arizona insurers to pay appointment fees, appointment renewal fees, appointment termination fees, license fees or license renewal fees. Make sure to post the total from this form to Form E-RT.