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. 

Warning - Phishing Scam

We are aware of a phishing scam targeting insurance professionals claiming that the National Association of Insurance Commissioners received a complaint that the professional submitted a falsified claim. This fraudulent email displays the NAIC and CIPR logos, can originate from what appears to be an or email account, and instructs the recipient to click on a link to download the complaint notification.

Certain antivirus products will detect this as a malicious email.  If you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or [email protected].

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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.