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Titlesort ascending Last updated Attachments
Form L-BRA: Notice of Bail Recovery Agent Utilization 01/08/2018 (Fri)
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PDF icon l-bra_20180618.pdf942.56 KB
Form L-BFP: Bail Recovery Agent Fingerprint Submission 01/08/2018 (Fri)
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PDF icon l-bfp_20180618.pdf941.99 KB
Form L-BBAR: Bail Bond Agent Annual Report 02/02/2019 (Wed)
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PDF icon Form L-BBAR (v. 20190118)1.02 MB
Form L-BBAA: Bail Bond Agent Affidavit of Residency 01/08/2018 (Fri)
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PDF icon l-bbaa_20180618.pdf923.26 KB
Form L-195: Bond of Bail Bond Agent 01/08/2018 (Fri)
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PDF icon l-195_20180618.pdf893.64 KB
Form L-193: Certificate of Assumed Name 01/08/2018 (Fri)
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PDF icon l-193_20180618.pdf953.21 KB
Form L-192: License Renewal Application for a Business Entity 02/04/2019 (Tue)
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File l-192_20190402.docx81.02 KB
Form L-191: License Renewal Application for an Individual 12/07/2019 (Mon)
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PDF icon form_l-191_0.pdf314.72 KB
Form L-177: Report of a Change to Members, Officers or Directors 01/02/2019 (Wed)
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PDF icon Form L-177618.01 KB
Form L-176: Insurance License Application for a Business Entity 03/07/2019 (Fri)
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PDF icon L-176-Form-and-Instructions_20190712.pdf477.29 KB
Form L-152: Licensing Eligibility (Lawful Presence in the US) Requirement 01/08/2018 (Fri)
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PDF icon Form L-152501.26 KB
Form II-Certification: Industrial Insured Certification 03/03/2015 (Mon)
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PDF icon Industrial Insured Certification (01-2015) New Heading.pdf18.47 KB
Form HIPAADATA: HIPAA Report 09/05/2015 (Fri)
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PDF icon HIPAADATA FORM 2015 PDF.pdf50.91 KB
Form F101: Fraud Referral Form 05/04/2019 (Sat)
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PDF icon Form F-101: Fraud Referral Form219.47 KB
Form EXSAPP: Application for Workers' Compensation Deposit Reduction - Instructions 12/06/2015 (Tue)
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PDF icon EXSAPP.pdf204.59 KB
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 ER002: Registration 08/07/2018 (Thu)
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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 ER001: Filing Instructions 04/02/2015 (Wed)
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PDF icon Form ER001: Filing Instructions153.63 KB
Form ER001: Filing Instructions 03/02/2015 (Wed)
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PDF icon Form ER001: Filing Instructions654.89 KB
FORM ER001 FOREIGN RISK RETENTION GROUP FILING INSTRUCTIONS 08/07/2018 (Thu)
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PDF icon Foreign Risk Retention Group Filing instructions E-R001.pdf58.69 KB
Form E478I: Arizona Special Schedule P Report Instructions 04/12/2014 (Wed)
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PDF icon E478I.pdf25.47 KB
Form E230: Change to Domestic Insurer Statutory Agent 04/11/2016 (Thu)
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PDF icon E230_0.pdf520.69 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 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 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 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 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 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 E185: Outline for Compliance with Insurance Holding Company Systems Reporting Requirements 09/07/2018 (Fri)
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PDF icon Holding Company Instructions E-185.pdf62.88 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 E157: Bond of Life and Health Administrator 02/12/2018 (Tue)
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PDF icon Bond of Life and Health Administrator 645.6 KB
Form E150 - Assignment of Certificate of Deposit or Time Deposit to Arizona State Treasurer 09/09/2018 (Tue)
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PDF icon E150.pdf752.53 KB

Pages

Tue, 09/10/2019 - 14:27

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].