NAIC Form 11: Biographical Affidavit

Must be completed by each partner, officer, and director, and each other entity owning 25% or more of a Service Company applicant.

Priority: 
NAIC011
Form L-191: License Renewal Application for an Individual

To make your renewal process faster and easier, use NIPR.COM and renew online instead of completing, printing and mailing this application.

Form L-192: License Renewal Application for a Business Entity

To make your renewal process faster and easier, use NIPR.COM and renew online instead of completing, printing and mailing this application.

Form L-193: Certificate of Assumed Name

Use this form for each name, other than your genuine legal name, that you intend to use in conjunction with your insurance business.  If you have established a business entity and want to use the name of the business entity in conjunction with your insurance transactions, the business entity must also hold an insurance license. 

Form L-195: Bond of Bail Bond Agent

A bail bond agent must provide and maintain throughout the term of the license a $10,000 surety bond.

Form L-BBAA: Bail Bond Agent Affidavit of Residency

An applicant for a bail bond agent license must attest and affirm continuous residency in Arizona during the preceding one-year period.

Form L-BBAR: Bail Bond Agent Annual Report

Each year, every bail bond agent must complete this report concerning bail recovery agents the bail bond agent employed, hired as independent contractors or otherwise used at any time during the previous calendar year.  The Insurance Licensing Section must receive the completed report by January 31.  ARS § 13-3885(D).

Form L-BFP: Bail Recovery Agent Fingerprint Submission

A bail recovery agent must complete this form and must include a clear 2" X 3" photograph of the bail recovery agent's face.

Form L-BRA: Notice of Bail Recovery Agent Utilization

A bail bond agent notification to the Department of Insurance of using a bail recovery agent.

Form L-CHG: License Information Change

Individuals needing to update address, phone and e-mail information must use the NIPR Contact Change Request (www.nipr.com) instead of using this form.  An individual may use this form to report a name change, and a business entity may use this form to report a change of Designated Producer, name, address, phone number or e-mail information.  

Form L-CLR: Clearance Letter Request

Use this form if:

A.  You are relocating to another state and need to provide a clearance letter from Arizona, OR

B.  You want to permanently surrender insurance license authority.  Be careful!  If you surrender insurance license authority, Arizona law prevents you from reapplying for the surrendered authority for one year. 

Form L-CRT: Certification Letter Request

Information concerning Arizona insurance licenses is available at no charge from the License Search menu option on our web site. Insurance companies and the public are encouraged this License Search feature (rather than a paper printout or a letter of certification) to verify the lines of authority, license issuance and expiration dates, and license status for an Arizona-licensed insurance professional.

Form L-FPV: Fingerprint Verification

This form is to be used by individuals who are required to submit fingerprints as part of an insurance license application. The form includes detailed instructions that must be exactly followed for fingerprints to be accepted by the Department of Insurance.

Form L-LOC: Branch Locations

Self Service Storage Agents and Rental Car Agents must specify all office locations from which the entity may transact insurance business.

Form L-LSB: Life Settlement Broker Application

Complete and file this form with the life settlement broker license fee within the first 30 days of operating as a life settlement broker. 

Form L-LTD: Limited License Authority Application

Only use this form to apply for a license as a portable electronics vendor, rental car agent, self-service storage agent, or travel insurance producer. 

Form L-NAV: Application for Navigator or Certified Application Counselor License

The document contains detailed instructions and forms to apply to become a navigator or certified application counselor. 

Form L-PFD: Petition for Determination

You can use this form to ask the Department of Insurance to determine whether a criminal conviction disqualifies you for a license.  

Form L-SURR: License Surrender Request

Only use this form to permanently surrender license authority.  If you wish to clear a license to allow you to become licensed in another state, use Form L-CLR.

Form L-TEMP: Application for a Temporary Insurance License

Submit

  • Form L-TEMP,
  • Form L-152 with a copy of both sides of one of listed forms of identification,
  • Fingerprints and Form L-FPV exactly as described on Form L-FPV, and
  • $142.00 (to cover the $120.00 license fee and $22.00 FBI fingerprint card processing fee). 
NAIC uniform license application for an Individual

To make your application process faster and easier, use NIPR.COM and apply online instead of completing, printing and mailing this application

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