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NEW ADDRESS
Arizona Department of Insurance
100 North 15th Avenue, Suite 261
Phoenix, AZ  85007-2630

Starting July 1, 2020, we will be the
Department of Insurance and Financial Institutions (DIFI).
(6) | " (1) | 0 (666) | 1 (1504) | 2 (88) | 3 (3) | 4 (7) | 5 (8) | 6 (20) | 7 (45) | 8 (107) | 9 (536) | > (1) | A (175) | B (22) | C (140) | D (44) | E (20) | F (275) | G (19) | H (57) | I (83) | J (2) | K (1) | L (58) | M (175) | N (83) | O (22) | P (229) | Q (1) | R (207) | S (53) | T (34) | U (13) | V (4) | W (66) | Y (3) | • (1)
Title Last updatedsort descending Attachments
Form SOONBDRFI-I: Request for Information - Insurer 03/01/2020 (Fri)
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PDF icon Form SOONBDRFI-I (v. 20190207)2.25 MB
Form E-CERTREQ: Certificate Request Form 11/01/2020 (Wed)
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PDF icon Certificate Request Form 20200110.pdf857.94 KB
Form SOONBDRIST: Informal Settlement Teleconference Outcome 02/01/2020 (Fri)
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PDF icon SOONBDRIST.pdf882.06 KB
Form E-AHCCCS: AHCCCS Contractor Quarterly Premium Tax Report 03/01/2020 (Fri)
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File e-ahcccs_20200131.xlsx56.77 KB
Form E-II: Industrial Insured Premium Receipts Tax Report 04/01/2020 (Fri)
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PDF icon Form E-II (v. 20200131)1.26 MB
Form E-RT: Retaliation Report 04/01/2020 (Fri)
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File Form E-RT (v. 20200131)75.71 KB
Form E-SGHI: Accountable Health Plan Small-employer Group Health Insurance Plan Premium 05/01/2020 (Fri)
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File Form E-SGHI (v. 20200131)418.44 KB
Form E-TC: Tax Credits 05/01/2020 (Fri)
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File Form E-TC (v. 20200131)49.83 KB
Form E-TITLE: Retaliation Report for a Foreign/Alien Title Insurer 05/01/2020 (Fri)
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File Form E-TITLE (v. 20200131)53.08 KB
Form E-FBS: Annual Fees and Retaliation Report for a Fraternal Benefit Society 05/01/2020 (Fri)
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PDF icon Form E-FBS (v. 20200131)896.35 KB
Form E-LRTF: Local and Regional Taxes and Fees; Survey of Arizona Domestic Insurers 05/01/2020 (Fri)
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File Local and Regional Taxes and Fees Report (Form E-LRTF, v. 20200131)1.03 MB
FOREIGN INSURER: Accredited Reinsurer 05/01/2020 (Fri)
FOREIGN INSURER: Exempt Insurer; Employee Benefit Trust/Association 06/01/2020 (Fri)
FOREIGN INSURER: Unaffiliated Credit Life & Disability Reinsurer 06/01/2020 (Fri)
Form E-TAX-I: Annual Tax and Fees Report Instructions 06/01/2020 (Fri)
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PDF icon Annual Tax and Fees Report Instructions (Form E-TAX-I)456.15 KB
Form E-LR.I: Annual Statement Filing Instructions 10/02/2020 (Mon)
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PDF icon Life and Disability Reinsurer Annual Instructions E-LRI (4).pdf170.25 KB
Form E-AFR.IC.RE: Audited Financial Report Internal Control Filings Transmittal Reinsurer 10/02/2020 (Mon)
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PDF icon Audited Financial Report Internal Control Filings E-AFR.IC_.RE (2).pdf1.01 MB
Form E-AFR.OHE: Audited Financial Report Organizational Hardship Exemption Guidelines and Sample Affidavit 10/02/2020 (Mon)
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PDF icon Audited Financial Report Organizational Hardship Exemption E-AFR-OHE (1).pdf170.38 KB
Form E-HCSO.13: Certificate of Advertising Compliance 10/02/2020 (Mon)
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PDF icon Certificate of Advertising Compliance E-HCSO.13.pdf659.24 KB
Form E-ACTOP: Actuarial Opinion Exemption Guidelines 10/02/2020 (Mon)
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PDF icon Actuarial Opinion Financial Hardship Exemption E-ACTOP.pdf769.5 KB
Form E-PC.350: Producer-controlled Property and Casualty Insurance Report 10/02/2020 (Mon)
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PDF icon Producer Controlled Report E-PC.350.pdf719.87 KB
Form E-NAIC.HEALTH: Annual Filing Checklist 10/02/2020 (Mon)
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PDF icon E-NAIC.HEALTH (2).pdf234.54 KB
Form E-NAIC.LD: Annual Filing Checklist 10/02/2020 (Mon)
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PDF icon E-NAIC.LD (2).pdf271.71 KB
Form E-NAIC.TITLE: Annual Filing Checklist 11/02/2020 (Mon)
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PDF icon E-NAIC.TITLE (2).pdf214.23 KB
Form E-178: Certificate of Disclosure 11/02/2020 (Mon)
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PDF icon Certificate of Disclosure E-178.pdf748.82 KB
Form E-NAIC.LD: Annual Filing Checklist 03/02/2020 (Tue)
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PDF icon E-NAIC.LD (2).pdf271.71 KB
Form E-TAX: Annual Tax and Fees Report 08/02/2020 (Tue)
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File E-TAX_20200131.xlsx94.22 KB
Form E-LR.AS: Annual Statement Filings Worksheet 10/02/2020 (Mon)
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PDF icon Life and Disability Reinsurer Annual Checklist E-LR.AS (2).pdf1.15 MB
Form E-AFR.GFE: Audited Financial Report Exemption Guidelines 10/02/2020 (Mon)
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PDF icon Audited Financial Report Guidelines for Exemptions E-AFR-GFE (2).pdf3.91 MB
Form E157: Bond of Life and Health Administrator 10/02/2020 (Wed)
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PDF icon Bond of Life and Health Administrator 663.96 KB
Form E-710: Application for Purchasing Group Registration 10/02/2020 (Wed)
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PDF icon Form E-710 Purchasing Group Application.pdf654.61 KB
Form E-711: Purchasing Group List of Insurers and Agents 10/02/2020 (Wed)
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PDF icon Form E-711 Purchasing Group List of Insurers and Agents.pdf656.58 KB
FORM ER001 FOREIGN RISK RETENTION GROUP FILING INSTRUCTIONS 10/02/2020 (Wed)
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PDF icon Foreign Risk Retention Group Filing instructions E-R001.pdf164.9 KB
Form ER002: Registration 10/02/2020 (Wed)
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PDF icon Foreign Risk Retention Group Registration Application E-R002.pdf691.81 KB
Form E-857: Bond of Service Company 10/02/2020 (Wed)
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PDF icon Form E-857 Bond of Service Company.pdf729.67 KB
Form E-811: Renewal of Service Company Permit 10/02/2020 (Wed)
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PDF icon Form E-811 Service Company Renewal.pdf974.48 KB

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