NAIC Form 11: Biographical Affidavit

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).


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

Priority: 
NAIC011
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

Form L-WAV: Fee Waiver Request

Only use this form (rather than paying the license fee) if you meet all the requirements on the form.  If you file this form, it becomes part of your license application, and if you file incorrect, misleading, incomplete, or materially untrue information on a license application, an insurance license can be denied, suspended or revoked, you could be assessed civil penalties and you could be the subject of other administrative and legal consequences.  The fee waiver only applies to the license fee.  It does not apply to other fees and costs you may need to pay in order to become licensed.

Form RO31010: License Application for a Rating Organization
Form RSO31010: License Application for a Rate Service Organization

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