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Titlesort descending Last updated Attachments
Form E-100: Application for Life and Health Administrator Registration 08/08/2019 (Mon)
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PDF icon Form E-100 TPA New Application 20190809.pdf1.72 MB
Form E-111: Renewal Application for Life and Health Administrator Registration 02/12/2018 (Tue)
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PDF icon Form E-111 TPA Renewal Application.pdf1.41 MB
Form E-115: Life and Health (Third-party) Administrator Information Update 02/12/2018 (Tue)
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PDF icon TPA Form E-1151.46 MB
Form E-178: Certificate of Disclosure 10/07/2018 (Tue)
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PDF icon E178_20180703.pdf726.07 KB
Form E-200: TPA Registration Application Checklist 02/12/2018 (Tue)
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PDF icon TPA Form E-200_20160721.pdf927.57 KB
Form E-503-TPA: Affidavit of Lost Certificate of Registration 03/12/2018 (Tue)
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PDF icon Form E-503-TPA Affidavit of Lost Certificate of Registration.pdf983.69 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
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-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-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-700: Certificate of Surplus Lines Broker 01/09/2018 (Tue)
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PDF icon Certificate of Surplus Lines Broker Form E-700.pdf1.22 MB
Form E-701: Certificate of Public Supervisory Official 01/09/2018 (Tue)
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PDF icon Certificate of Public Supervisory Official Form E-701.pdf1.47 MB
Form E-710: Application for Purchasing Group Registration 03/06/2018 (Tue)
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PDF icon Form E-710 Purchasing Group Application.pdf632.76 KB
Form E-711: Purchasing Group List of Insurers and Agents 03/06/2018 (Tue)
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PDF icon Form E-711 Purchasing Group List of Insurers and Agents.pdf638.14 KB
Form E-800-B: Service Company Biographical List 03/06/2018 (Tue)
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PDF icon Form E-800-B Service Company Application Biographical List.pdf726.83 KB
Form E-800: Application for Service Company Permit 09/08/2018 (Tue)
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PDF icon Form E-800 Service Company Application1017.23 KB
Form E-801: Motor Vehicle Dealer's Notice of Intent 03/06/2018 (Tue)
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PDF icon Form E-801 Motor Vehicle Dealer's Notice of Intent.pdf748.71 KB
Form E-811: Renewal of Service Company Permit 09/08/2018 (Tue)
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PDF icon Form E-811 Service Company Renawal952.57 KB
Form E-820: Service Company Application Checklist 11/08/2018 (Tue)
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PDF icon Form E-820 Service Company Review Checklist817.73 KB
Form E-857: Bond of Service Company 03/06/2018 (Tue)
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PDF icon Form E-857 Bond of Service Company.pdf707.69 KB
Form E-ACTOP: Actuarial Opinion Exemption Guidelines 12/01/2019 (Tue)
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PDF icon Actuarial Opinion Financial Hardship Exemption E-ACTOP.WebVersion.pdf747.73 KB
Form E-AFR.GFE: Audited Financial Report Exemption Guidelines 03/11/2018 (Tue)
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PDF icon Audited Financial Report Guidelines for Exemptions E-AFR-GFE.pdf3.8 MB
Form E-AFR.IC.RE: Audited Financial Report Internal Control Filings Transmittal Reinsurer 02/06/2019 (Thu)
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PDF icon Audited Financial Report Internal Control Filings E-AFR.IC_.RE_.pdf594.89 KB
Form E-AFR.IC: Audited Financial Report Internal Control Filings Transmittal 02/06/2019 (Thu)
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PDF icon Audited Financial Report Internal Control Filings E-AFR.IC_.WebVersion.pdf760.83 KB
Form E-AFR.OHE: Audited Financial Report Organizational Hardship Exemption Guidelines and Sample Affidavit 03/11/2018 (Tue)
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PDF icon Audited Financial Report Organizational Hardship Exemption E-AFR-OHE.pdf3.68 MB
Form E-AHCCCS: AHCCCS Contractor Quarterly Premium Tax Report 09/01/2019 (Fri)
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File Form E-AHCCCS56.59 KB
Form E-AMEND: Summary to Changes to Taxes and Fees 12/01/2018 (Sat)
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File e-amend.xlsx69.07 KB
Form E-AR-1: Certificate of Assuming Insurer 08/07/2018 (Thu)
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PDF icon Reinsurer E-AR-1 Certificate of Assuming Insurer.pdf1.49 MB
Form E-CERTREQ: Certificate Request Form 10/07/2018 (Tue)
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PDF icon Certificate Request Form964.81 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-CR-C: Uniform Application Checklist for Certified Reinsurers 09/07/2018 (Fri)
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PDF icon Certified Reinsurer E-CR-C Application Checklist.pdf1.24 MB
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-CR-INFO: Certified Reinsurer Information 03/10/2019 (Thu)
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PDF icon Certified Reinsurer E-CR-INFO Information 20191017.pdf158.92 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-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

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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].