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Title Last updatedsort descending Attachments
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 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 ER002: Registration 08/07/2018 (Thu)
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PDF icon Foreign Risk Retention Group Registration Application E-R002.pdf659.3 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-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-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-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 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 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 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 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 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 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-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-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 L-TEMP: Application for a Temporary Insurance License 01/08/2018 (Fri)
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PDF icon l-temp_20180618.pdf63.23 KB
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-SURR: License Surrender Request 01/08/2018 (Fri)
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PDF icon l-surr_20180618.pdf1.02 MB
Form RSO31010: License Application for a Rate Service Organization 01/08/2018 (Fri)
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Microsoft Office document icon RateSerOrgapp31010.doc37 KB
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-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 L-CLR: Clearance Letter Request 01/08/2018 (Fri)
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PDF icon l-clr_20180618.pdf1.04 MB
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-CHG: License Information Change 01/08/2018 (Fri)
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PDF icon l-chg_20180618.pdf949.18 KB
Form L-FPV: Fingerprint Verification 01/08/2018 (Fri)
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PDF icon l-fpv_20180618.pdf62 KB
Form L-LSB: Life Settlement Broker Application 01/08/2018 (Fri)
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PDF icon l-lsb_20180618.pdf87.3 KB
Form L-NAV: Application for Navigator or Certified Application Counselor License 01/08/2018 (Fri)
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PDF icon form_l-nav.pdf600.85 KB
Form L-LOC: Branch Locations 01/08/2018 (Fri)
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PDF icon l-loc_20180618.pdf1.03 MB
Form RO31010: License Application for a Rating Organization 01/08/2018 (Fri)
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Microsoft Office document icon RatingOrgApp31010.doc35.5 KB
Form L-PFD: Petition for Determination 01/08/2018 (Fri)
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PDF icon Form L-PFD216.64 KB
Form E125-CD: Certificate of Deposit Transmittal 09/09/2018 (Tue)
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PDF icon E125CD.pdf699.49 KB
Form E126LOC: Request for Release of Letter of Credit 09/09/2018 (Tue)
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PDF icon E126LOC.pdf635.16 KB

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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].