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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
Form ER002: Registration Application 09/07/2018 (Fri)
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PDF icon Foreign Risk Retention Group Registration Application E-R002.pdf659.3 KB
Form ER001: Filing Instructions 09/07/2018 (Fri)
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PDF icon Foreign Risk Retention Group Filing instructions E-R001.pdf58.69 KB
Form E185F: Instructions for the completion of the Enterprise Risk Report 09/07/2018 (Fri)
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PDF icon Holding Company Form F E-185F.pdf57.92 KB
Form E185B: Instructions for the Completion of the Form B Registration Statement 09/07/2018 (Fri)
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PDF icon Holding Company Form B E-185B.pdf69.47 KB
Form E-CR-1: Certificate of Certified Reinsurer 08/07/2018 (Thu)
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PDF icon Certified Reinsurer E-CR-1 Certificate.pdf1.84 MB
Form E-654: Application for Life Care Provider Permit Change 08/07/2018 (Thu)
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PDF icon Life Care Provider Permit Change E-654.pdf646.21 KB
Form E-652: Application for Life Care Provider Permit 08/07/2018 (Thu)
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PDF icon Life Care Provider Permit Application E-652.pdf673.06 KB
Form E-SR.AFR: Sr. Residential Entrance Fee Contracts: Provider Annual Audited Financial Report Transmittal Form 08/07/2018 (Thu)
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PDF icon Sr. Residential Entrance Fee Contract Provider Annual AFR Transmittal E-SR.AFR_.pdf159.17 KB
Form E-SR.INSTR: Sr. Residential Entrance Fee Contracts: Provider Compliance With A.R.S. Title 44, Chapter 25, Article 1 08/07/2018 (Thu)
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PDF icon Sr. Residential Entrance Fee Contract Provider E-SR.INSTR_.pdf54.07 KB
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
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-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-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-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-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-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 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 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 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 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 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 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 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 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 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 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-CR-S Instructions 03/06/2018 (Tue)
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PDF icon Form E-CR-S Instructions56.67 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-I: Certified Reinsurer Instructions 02/06/2018 (Tue)
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PDF icon Certified Reinsurer CR-I Instructions.pdf57.17 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-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 E-651: Checklist for Application for Life Care Provider Permit 02/06/2018 (Tue)
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PDF icon AdmLifeCareE651.pdf52.06 KB
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
Finding a License Record 07/04/2018 (Sun)
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PDF icon FindingALicenseRecord.pdf178.19 KB
Form E-INSTALL: Tax Installment Report 11/01/2018 (Wed)
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File Form E-INSTALL3.62 MB
Form E-TAX-AGENTS: 12/01/2018 (Sat)
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File Form E-TAX-AGENTS4.01 MB

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