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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 ascending Last updated Attachments
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-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.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-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-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-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-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-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-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-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-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-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-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-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-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 (1).pdf1.13 MB
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-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.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-INSTALL: Tax Installment Report 11/01/2018 (Wed)
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File Form E-INSTALL3.62 MB
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-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-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-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
Form E-CR-S Instructions 03/06/2018 (Tue)
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PDF icon Form E-CR-S Instructions56.67 KB
Form E-CR-INFO: Certified Reinsurer Information 02/02/2020 (Fri)
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PDF icon Certified Reinsurer E-CR-INFO Information 20200213.pdf160.6 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-F Instructions 03/06/2018 (Tue)
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PDF icon Form E-CR-F51.96 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-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-CERTREQ: Certificate Request Form 11/01/2020 (Wed)
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PDF icon Certificate Request Form 20200110.pdf857.94 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-AMEND: Summary to Changes to Taxes and Fees 12/01/2018 (Sat)
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File e-amend.xlsx69.07 KB
Form E-AHCCCS: AHCCCS Contractor Quarterly Premium Tax Report 03/01/2020 (Fri)
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File e-ahcccs_20200131.xlsx56.77 KB
Form E-AFR.OHE: Audited Financial Report Organizational Hardship Exemption Guidelines and Sample Affidavit 10/02/2020 (Mon)
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PDF icon Audited Financial Report Organizational Hardship Exemption E-AFR-OHE (1).pdf170.38 KB
Form E-AFR.IC: Audited Financial Report Internal Control Filings Transmittal 11/11/2019 (Thu)
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PDF icon Audited Financial Report Internal Control Filings E-AFR.IC_.pdf1.35 MB
Form E-AFR.IC.RE: Audited Financial Report Internal Control Filings Transmittal Reinsurer 10/02/2020 (Mon)
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PDF icon Audited Financial Report Internal Control Filings E-AFR.IC_.RE (2).pdf1.01 MB

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