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Title Last updatedsort descending Attachments
Flooding after Wildfires: Department of Emergency and Military Affairs 05/04/2018 (Tue)
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PDF icon DEMA_PR_re_flooding_after_fires_0.pdf149.78 KB
Form E-651: Checklist for Application for Life Care Provider Permit 02/06/2018 (Tue)
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PDF icon AdmLifeCareE651.pdf52.06 KB
Form E-653: Checklist for Change from a Provisional Permit to Life Care Provider Permit 02/06/2018 (Tue)
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PDF icon Form E-65354.28 KB
Form SL-112: Application for Domestic Surplus Lines Insurer Designation 02/06/2018 (Tue)
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PDF icon Form SL-112 Domestic Surplus Lines Insurer 20180619.pdf777.3 KB
Form E-RE-I: Reinsurer Initial Instructions 02/06/2018 (Tue)
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PDF icon E-RE-I (Instructions)52.68 KB
Form E-CR-I: Certified Reinsurer Instructions 02/06/2018 (Tue)
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PDF icon Certified Reinsurer CR-I Instructions.pdf57.17 KB
Form E-CR-F Instructions 03/06/2018 (Tue)
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PDF icon Form E-CR-F51.96 KB
Form E-CR-S Instructions 03/06/2018 (Tue)
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PDF icon Form E-CR-S Instructions56.67 KB
Form E-RE-A: Reinsurer Annual Instructions 03/06/2018 (Tue)
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PDF icon Reinsurer RE-A Instructions.pdf51.71 KB
Form E-800-B: Service Company Biographical List 03/06/2018 (Tue)
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PDF icon Form E-800-B Service Company Application Biographical List.pdf726.83 KB
Form E-801: Motor Vehicle Dealer's Notice of Intent 03/06/2018 (Tue)
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PDF icon Form E-801 Motor Vehicle Dealer's Notice of Intent.pdf748.71 KB
Form E-857: Bond of Service Company 03/06/2018 (Tue)
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PDF icon Form E-857 Bond of Service Company.pdf707.69 KB
Form E-710: Application for Purchasing Group Registration 03/06/2018 (Tue)
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PDF icon Form E-710 Purchasing Group Application.pdf632.76 KB
Form E-711: Purchasing Group List of Insurers and Agents 03/06/2018 (Tue)
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PDF icon Form E-711 Purchasing Group List of Insurers and Agents.pdf638.14 KB
Form E-178: Certificate of Disclosure 10/07/2018 (Tue)
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PDF icon E178_20180703.pdf726.07 KB
Form E-UCLDR.AS: Annual Statement Filing Worksheet 10/07/2018 (Tue)
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PDF icon Form E-UCLDR.AS Worksheet110.9 KB
Form E-UCLDR.CERT: Certification 10/07/2018 (Tue)
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PDF icon Form E-UCLDR.Cert1.22 MB
Form E-UCLDR.I: Annual Statement Filing Instructions 10/07/2018 (Tue)
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PDF icon Form E-UCLDR Instructions62.01 KB
Form C-RFI 03/07/2018 (Mon)
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PDF icon form_c-rfi.pdf850.66 KB
Form E-CERTREQ: Certificate Request Form 10/07/2018 (Tue)
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PDF icon Certificate Request Form964.81 KB
Form E185C: Instructions for the Completion of the Form C Summary of Registration Statement 07/07/2018 (Thu)
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PDF icon Holding Company Form C E-185C.pdf55.92 KB
Form E185CHB: Instructions for a Change to Form B Registration Statement 07/07/2018 (Thu)
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PDF icon Holding Company Form B Change E-185CHB.pdf54.79 KB
Form E185CHC: Instructions for a Change to Form C Summary of Registration Statement 07/07/2018 (Thu)
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PDF icon Holding Company Form C Change E-185CHC.pdf54.96 KB
Form E185XD: Instructions for Approval of Extraordinary Dividends and Other Distributions 07/07/2018 (Thu)
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PDF icon Holding Company Extraordinary Dividends E-185XD.pdf54.25 KB
Form E185D: Instructions for the Completion of the Form D Prior Notice of a Transaction Pursuant to A.R.S. § 20-481.12 07/07/2018 (Thu)
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PDF icon Holding Company Form D E-185D.pdf64.49 KB
FORM E-DIRCOMWAIVER: Arizona Domestic Insurers Board of Directors and/or Committees Waiver Application 08/07/2018 (Thu)
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PDF icon Holding Company Directors Committees Waiver E-DIRCOMWAIVER.pdf58.58 KB
Form E185F: Instructions for the Completion of the Enterprise Risk Report 08/07/2018 (Thu)
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PDF icon Holding Company Form F E-185F.pdf57.92 KB
Form E185E: Instructions for the Completion of the Pre-acquisition Notification Form 08/07/2018 (Thu)
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PDF icon Holding Company Form E E-185E.pdf56.32 KB
Form E184: Instructions for the Completion of the Form A Statement Regarding the Acquisition of Control of, or Merger with, a Domestic Insurer 08/07/2018 (Thu)
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PDF icon Holding Company Form A E-184.pdf70.45 KB
Form E-LSP3: Life Settlement Provider Report of Officers, Directors, Members, Partners and Designated Employees 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSP3.pdf98.12 KB
Form E-LSPI: Life Settlement Provider Application for Certificate of Authority - Instructions 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSPI.pdf160.25 KB
Form E-LSP1: Life Settlement Provider Application for Certificate of Authority 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSP1.pdf98.9 KB
Form E-LSP2: Life Settlement Provider Report of Stockholders/Owners 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSP2.pdf98.87 KB
Form E-LSP4: Life Settlement Provider Statutory Agent Appointment and Acceptance 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSP4.pdf112.27 KB
Form E-LSPS: Life Settlement Provider Annual Statement 08/07/2018 (Thu)
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PDF icon Life Settlement Provider Annual Statement E-LSPS.pdf1.36 MB
Form E-LSPF: Life Settlement Provider Anti-fraud Plan Checklist 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSPF.pdf584.2 KB

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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 naic.org or gmail.com 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].