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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).
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Title
Last updated
Attachments
Form E-UCLDR.AS: Annual Statement Filing Worksheet
08/07/2020 (Thu)
Attachment
Size
E-UCLDR.AS 20200701.pdf
211.9 KB
Form E-UCLDR.I: Annual Statement Filing Instructions
08/07/2020 (Thu)
Attachment
Size
E-UCLDR.I 20200701.pdf
159.56 KB
Form E-UCLDR.CERT: Certification
08/07/2020 (Thu)
Attachment
Size
E-UCLDRCert 20200701.pdf
164.2 KB
Fire Readiness and Your Insurance Coverage
06/06/2020 (Wed)
Attachment
Size
Fire Readiness and Your Insurance Coverage 20200622.pdf
281.62 KB
Form C-TPC: Third-party Consent
09/05/2020 (Fri)
Attachment
Size
3rd Party Consent2.pdf
1.28 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)
Attachment
Size
l-prv_20200415_1530.pdf
323.51 KB
Form E-AR-1: Certificate of Assuming Insurer
10/03/2020 (Fri)
Attachment
Size
Reinsurer E-AR-1 Certificate of Assuming Insurer.pdf
811.39 KB
Form E-NAIC.PC: Annual Filing Checklist
01/03/2020 (Mon)
Attachment
Size
E-NAIC.PC (3).pdf
262.88 KB
Form E-CR-INFO: Certified Reinsurer Information
01/03/2020 (Mon)
Attachment
Size
Certified Reinsurer E-CR-INFO Information 20200314.pdf
161.25 KB
Form E185: Outline for Compliance with Insurance Holding Company Systems Reporting Requirements
01/03/2020 (Mon)
Attachment
Size
Holding Company Instructions E-185 (1).pdf
213.84 KB
Filing a Health Care Appeal
10/03/2020 (Wed)
Form E126 Cash: Cash Release Form
09/03/2020 (Mon)
Attachment
Size
E126 Cash 20200302.pdf
192.75 KB
Form E126: Security Release Form
09/03/2020 (Mon)
Attachment
Size
E126 Security 20200302.pdf
105.52 KB
Form E125: Security Deposit Form
09/03/2020 (Mon)
Attachment
Size
E125 20200302.pdf
80.53 KB
Form L-BBAR: Bail Bond Agent Annual Report
11/03/2020 (Wed)
Attachment
Size
l-bbar_202000303.pdf
111.06 KB
Form SOONBDRR: Surprise Out-of-Network Billing Dispute Resolution Request
02/02/2020 (Thu)
Attachment
Size
SOONBDR_RequestForm_Fillable.pdf
2.15 MB
Form C-RFI
10/02/2020 (Thu)
Attachment
Size
c-rfi_20200221.pdf
1.38 MB
Form SL-112: Application for Domestic Surplus Lines Insurer Designation
10/02/2020 (Wed)
Attachment
Size
Form SL-112 Domestic Surplus Lines Insurer.pdf
806.07 KB
Form E-701: Certificate of Public Supervisory Official
10/02/2020 (Wed)
Attachment
Size
Certificate of Public Supervisory Official Form E-701 (1).pdf
1.49 MB
Form E-700: Certificate of Surplus Lines Broker
10/02/2020 (Wed)
Attachment
Size
Certificate of Surplus Lines Broker Form E-700 (1).pdf
1.24 MB
Form E-800-B: Service Company Biographical List
10/02/2020 (Wed)
Attachment
Size
Form E-800-B Service Company Application Biographical List.pdf
745.27 KB
Form E-801: Motor Vehicle Dealer's Notice of Intent
10/02/2020 (Wed)
Attachment
Size
Form E-801 Motor Vehicle Dealer's Notice of Intent.pdf
770.74 KB
Form E-800: Application for Service Company Permit
10/02/2020 (Wed)
Attachment
Size
Form E-800 Service Company Application.pdf
1.01 MB
Form E-811: Renewal of Service Company Permit
10/02/2020 (Wed)
Attachment
Size
Form E-811 Service Company Renewal.pdf
974.48 KB
Form E-857: Bond of Service Company
10/02/2020 (Wed)
Attachment
Size
Form E-857 Bond of Service Company.pdf
729.67 KB
Form ER002: Registration
10/02/2020 (Wed)
Attachment
Size
Foreign Risk Retention Group Registration Application E-R002.pdf
691.81 KB
FORM ER001 FOREIGN RISK RETENTION GROUP FILING INSTRUCTIONS
10/02/2020 (Wed)
Attachment
Size
Foreign Risk Retention Group Filing instructions E-R001.pdf
164.9 KB
Form E-711: Purchasing Group List of Insurers and Agents
10/02/2020 (Wed)
Attachment
Size
Form E-711 Purchasing Group List of Insurers and Agents.pdf
656.58 KB
Form E-710: Application for Purchasing Group Registration
10/02/2020 (Wed)
Attachment
Size
Form E-710 Purchasing Group Application.pdf
654.61 KB
Form E157: Bond of Life and Health Administrator
10/02/2020 (Wed)
Attachment
Size
Bond of Life and Health Administrator
663.96 KB
Form E-AFR.GFE: Audited Financial Report Exemption Guidelines
10/02/2020 (Mon)
Attachment
Size
Audited Financial Report Guidelines for Exemptions E-AFR-GFE (2).pdf
3.91 MB
Form E-LR.AS: Annual Statement Filings Worksheet
10/02/2020 (Mon)
Attachment
Size
Life and Disability Reinsurer Annual Checklist E-LR.AS (2).pdf
1.15 MB
Form E-TAX: Annual Tax and Fees Report
08/02/2020 (Tue)
Attachment
Size
E-TAX_20200131.xlsx
94.22 KB
Form E-NAIC.LD: Annual Filing Checklist
03/02/2020 (Tue)
Attachment
Size
E-NAIC.LD (2).pdf
271.71 KB
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