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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).

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Title Last updatedsort ascending Attachments
Filing a Health Care Appeal 01/09/2020 (Fri)
FY 2022 Agency Budget Request 09/09/2020 (Tue)
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PDF icon DIFI_FY2022_AgencyBudgetRequest-20200831.pdf28.84 MB
Form L-FPV: Fingerprint Verification 10/08/2020 (Tue)
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PDF icon l-fpv_20180618.pdf62 KB
FY 2021 Agency Strategic Plan 05/07/2020 (Thu)
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PDF icon ID-StrategicPlan-20200715.pdf84.92 KB
FY 2021 Insurer Notice of Assessment 05/07/2020 (Mon)
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PDF icon 2021-NoticeOfAssessment-20200713.pdf11.56 MB
Form E-UCLDR.AS: Annual Statement Filing Worksheet 08/07/2020 (Thu)
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PDF icon E-UCLDR.AS 20200701.pdf211.9 KB
Form E-UCLDR.I: Annual Statement Filing Instructions 08/07/2020 (Thu)
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PDF icon E-UCLDR.I 20200701.pdf159.56 KB
Form E-UCLDR.CERT: Certification 08/07/2020 (Thu)
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PDF icon E-UCLDRCert 20200701.pdf164.2 KB
Fire Readiness and Your Insurance Coverage 06/06/2020 (Wed)
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PDF icon Fire Readiness and Your Insurance Coverage 20200622.pdf281.62 KB
Form C-TPC: Third-party Consent 09/05/2020 (Fri)
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PDF icon 3rd Party Consent2.pdf1.28 MB
FINANCIAL REPORTING - DOMESTIC: Captive Insurer 12/05/2020 (Fri)
File a Complaint or Appeal 12/04/2020 (Sat)
Form L-PRV: Application for Provisional License 03/04/2020 (Thu)
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PDF icon l-prv_20200415_1530.pdf323.51 KB
Form E-AR-1: Certificate of Assuming Insurer 10/03/2020 (Fri)
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PDF icon Reinsurer E-AR-1 Certificate of Assuming Insurer.pdf811.39 KB
Form E-NAIC.PC: Annual Filing Checklist 01/03/2020 (Mon)
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PDF icon E-NAIC.PC (3).pdf262.88 KB
Form E-CR-INFO: Certified Reinsurer Information 01/03/2020 (Mon)
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PDF icon Certified Reinsurer E-CR-INFO Information 20200314.pdf161.25 KB
Form E185: Outline for Compliance with Insurance Holding Company Systems Reporting Requirements 01/03/2020 (Mon)
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PDF icon Holding Company Instructions E-185 (1).pdf213.84 KB
Form E126 Cash: Cash Release Form 09/03/2020 (Mon)
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PDF icon E126 Cash 20200302.pdf192.75 KB
Form E126: Security Release Form 09/03/2020 (Mon)
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PDF icon E126 Security 20200302.pdf105.52 KB
Form E125: Security Deposit Form 09/03/2020 (Mon)
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PDF icon E125 20200302.pdf80.53 KB
Form L-BBAR: Bail Bond Agent Annual Report 11/03/2020 (Wed)
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PDF icon l-bbar_202000303.pdf111.06 KB
Form SOONBDRR: Surprise Out-of-Network Billing Dispute Resolution Request 02/02/2020 (Thu)
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PDF icon SOONBDR_RequestForm_Fillable.pdf2.15 MB
Form C-RFI 10/02/2020 (Thu)
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PDF icon c-rfi_20200221.pdf1.38 MB
Form SL-112: Application for Domestic Surplus Lines Insurer Designation 10/02/2020 (Wed)
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PDF icon Form SL-112 Domestic Surplus Lines Insurer.pdf806.07 KB
Form E-701: Certificate of Public Supervisory Official 10/02/2020 (Wed)
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PDF icon Certificate of Public Supervisory Official Form E-701 (1).pdf1.49 MB
Form E-700: Certificate of Surplus Lines Broker 10/02/2020 (Wed)
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PDF icon Certificate of Surplus Lines Broker Form E-700 (1).pdf1.24 MB
Form E-800-B: Service Company Biographical List 10/02/2020 (Wed)
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PDF icon Form E-800-B Service Company Application Biographical List.pdf745.27 KB
Form E-801: Motor Vehicle Dealer's Notice of Intent 10/02/2020 (Wed)
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PDF icon Form E-801 Motor Vehicle Dealer's Notice of Intent.pdf770.74 KB
Form E-800: Application for Service Company Permit 10/02/2020 (Wed)
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PDF icon Form E-800 Service Company Application.pdf1.01 MB
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
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 ER002: Registration 10/02/2020 (Wed)
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PDF icon Foreign Risk Retention Group Registration Application E-R002.pdf691.81 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 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 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 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

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