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

NEW AGENCY


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).


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

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Form E-700: Certificate of Surplus Lines Broker

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 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.

List of Domestic Surplus Lines Insurers

Surplus lines brokers must place business with an Arizona-authorized insurer when insurance is procurable from an authorized insurer.  When insurance is not procurable from an authorized insurer, a surplus lines broker may procure coverage from a Domestic Surplus Lines Insurer, from an insurer on Arizona's List of Qualified Unauthorized Surplus Line Insurers, or from an insurer on the NAIC Quarterly Listing of Alien Insurers.