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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).


(6) | " (1) | 0 (665) | 1 (1502) | 2 (90) | 3 (3) | 4 (7) | 5 (8) | 6 (20) | 7 (46) | 8 (107) | 9 (536) | > (1) | A (175) | B (22) | C (140) | D (44) | E (20) | F (277) | G (19) | H (57) | I (83) | J (2) | K (1) | L (58) | M (175) | N (84) | O (22) | P (229) | Q (1) | R (207) | S (53) | T (34) | U (13) | V (4) | W (66) | Y (3) | (1)
Titlesort ascending Last updated Attachments
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 01/03/2020 (Mon)
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PDF icon Holding Company Instructions E-185 (1).pdf213.84 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 10/02/2020 (Wed)
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PDF icon Bond of Life and Health Administrator 663.96 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
Form E126XS: Application and Order for Release of Excess Deposit 09/09/2018 (Tue)
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PDF icon E126XS.pdf1.2 MB
Form E126LOC: Request for Release of Letter of Credit 09/09/2018 (Tue)
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PDF icon E126LOC.pdf635.16 KB
Form E126: Security Release Form 09/03/2020 (Mon)
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PDF icon E126 Security 20200302.pdf105.52 KB
Form E126-CD: Request for Release of Certificate of Deposit 09/09/2018 (Tue)
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PDF icon E126CD.pdf696.61 KB
Form E126 Cash: Cash Release Form 09/03/2020 (Mon)
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PDF icon E126 Cash 20200302.pdf192.75 KB
Form E125: Security Deposit Form 09/03/2020 (Mon)
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PDF icon E125 20200302.pdf80.53 KB
Form E125-CD: Certificate of Deposit Transmittal 09/09/2018 (Tue)
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PDF icon E125CD.pdf699.49 KB
Form E110: Biographical Affidavit 07/12/2014 (Thu)
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PDF icon E110AZBiographicalAffidavit.pdf321.21 KB
Form E110: Biographical Affidavit 08/11/2014 (Fri)
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PDF icon E110AZBiographicalAffidavit.pdf321.21 KB
Form E-UCLDR: Unaffiliated Credit Life & Disability Reinsurer Annual Fees Report 11/01/2019 (Fri)
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PDF icon Form E-UCLDR (v. 20181217)366.26 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
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-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-TC: Tax Credits 05/01/2020 (Fri)
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File Form E-TC (v. 20200131)49.83 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-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-TAX-AGENTS: 12/01/2018 (Sat)
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File Form E-TAX-AGENTS4.01 MB
Form E-SR.REG: Sr. Residential Entrance Fee Contracts: Provider Registration 01/09/2018 (Tue)
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PDF icon Sr. Residential Entrance Fee Contract Provider E-SR.REG_.pdf603.68 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-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-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-RT: Retaliation Report 04/01/2020 (Fri)
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File Form E-RT (v. 20200131)75.71 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-RE-A: Reinsurer Annual Instructions 03/06/2018 (Tue)
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PDF icon Reinsurer RE-A Instructions.pdf51.71 KB
Form E-RE-A: Reinsurer Annual Instructions 10/09/2018 (Thu)
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PDF icon Reinsurer E-RE-A Instructions.pdf51.71 KB
Form E-PC.INDINS: Report of Policies Issued to Industrial Insureds 03/11/2018 (Tue)
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PDF icon Indistrial Insured E-PC.INDINS.pdf724.32 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

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