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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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Titlesort descending Last updated Attachments
Form E-FBS: Annual Fees and Retaliation Report for a Fraternal Benefit Society 05/01/2020 (Fri)
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PDF icon Form E-FBS (v. 20200131)896.35 KB
Form E-HCSO.13: Certificate of Advertising Compliance 10/02/2020 (Mon)
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PDF icon Certificate of Advertising Compliance E-HCSO.13.pdf659.24 KB
Form E-II: Industrial Insured Premium Receipts Tax Report 04/01/2020 (Fri)
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PDF icon Form E-II (v. 20200131)1.26 MB
Form E-INSTALL: Tax Installment Report 11/01/2018 (Wed)
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File Form E-INSTALL3.62 MB
Form E-LIFECARE.AMEND: Amendment to Annual Report 12/01/2019 (Tue)
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PDF icon Life Care Provider Annual Report Amendment E-LIFECARE.AMEND_.WebVersion.pdf703.64 KB
Form E-LIFECARE.AS: Annual Report Filing Checklist 01/11/2019 (Tue)
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PDF icon Life Care Provider Annual Report Filing Checklist E-LIFECARE.AS_.pdf870.89 KB
Form E-LIFECARE: Annual Report Form 01/11/2019 (Tue)
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PDF icon Life Care Provider Annual Report E-LIFECARE.pdf3.56 MB
Form E-LR.AS: Annual Statement Filings Worksheet 10/02/2020 (Mon)
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PDF icon Life and Disability Reinsurer Annual Checklist E-LR.AS (2).pdf1.15 MB
Form E-LR.I: Annual Statement Filing Instructions 10/02/2020 (Mon)
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PDF icon Life and Disability Reinsurer Annual Instructions E-LRI (4).pdf170.25 KB
Form E-LRTF: Local and Regional Taxes and Fees; Survey of Arizona Domestic Insurers 05/01/2020 (Fri)
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File Local and Regional Taxes and Fees Report (Form E-LRTF, v. 20200131)1.03 MB
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-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-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 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-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-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-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-MG.CEDE: Supplementary Schedule F-3 09/04/2019 (Mon)
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PDF icon Mortgage Guaranty Cede E-MG.CEDE (2).pdf167.38 KB
Form E-MG.MPP: Report of Policyholders Position 01/11/2019 (Tue)
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PDF icon Mortgage Guaranty MPP E-MG.MPP_.pdf1.24 MB
Form E-MRR.05: Annual Report of Policy and Loss Reserves and Application for Certificate of Authority Renewal 03/11/2018 (Tue)
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PDF icon Form E-MRR.05787.98 KB
Form E-MRR.AS: Annual Statement Filings Worksheet 09/12/2018 (Thu)
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PDF icon Form E-MRR.AS 1.11 MB
Form E-MRR.I: Annual Statement Filing Instructions 08/05/2019 (Fri)
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PDF icon Mechanical Reimbursement Reinsurer Annual Instructions E-MRRI (3).pdf143.37 KB
Form E-NAIC.HEALTH: Annual Filing Checklist 10/02/2020 (Mon)
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PDF icon E-NAIC.HEALTH (2).pdf234.54 KB
Form E-NAIC.LD: Annual Filing Checklist 03/02/2020 (Tue)
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PDF icon E-NAIC.LD (2).pdf271.71 KB
Form E-NAIC.LD: Annual Filing Checklist 10/02/2020 (Mon)
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PDF icon E-NAIC.LD (2).pdf271.71 KB
Form E-NAIC.PC: Annual Filing Checklist 01/03/2020 (Mon)
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PDF icon E-NAIC.PC (3).pdf262.88 KB
Form E-NAIC.TITLE: Annual Filing Checklist 11/02/2020 (Mon)
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PDF icon E-NAIC.TITLE (2).pdf214.23 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
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-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-RE-I: Reinsurer Initial Instructions 02/06/2018 (Tue)
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PDF icon E-RE-I (Instructions)52.68 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-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-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

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