NEW ADDRESS Starting January 27, 2020

Arizona Department of Insurance

100 North 15th Avenue, Suite 261

Phoenix, AZ  85007-2630

VISITORS

Citizens, license applicants, process servers:

  • We will continue to provide assistance from Suite 102 through Friday, January 24, 2020. 
  • We will be up and running in Suite 261 starting Monday, January 27, 2020.

 

    MAIL

    Send mail to our new suite number effective immediately (before January 27, 2020). 

    Please make sure to update our address in your contact lists and information systems.

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    Title Last updatedsort descending Attachments
    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 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-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-RE-A: Reinsurer Annual Instructions 10/09/2018 (Thu)
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    PDF icon Reinsurer E-RE-A Instructions.pdf51.71 KB
    FY 2019 INSURER ANNUAL ASSESSMENT INVOICES ARE AVAILABLE 02/09/2018 (Wed)
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    PDF icon AssessmentNoticesFY2019_20180710.pdf10.22 MB
    Filing a Complaint 02/10/2018 (Wed)
    For Captives Other Than RRGs: Captive Insurer Annual Report and Renewal Fee Transmittal 03/10/2018 (Mon)
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    PDF icon Captive AR-Transmittal 10 2018.SAVEABLE.pdf840.41 KB
    FINANCIAL REPORTING - DOMESTIC: Captive Insurer 03/10/2018 (Mon)
    For Risk Retention Groups: Captive Insurer Annual Report and Renewal Fee Transmittal 03/10/2018 (Mon)
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    PDF icon Captive RRG - Annual Transmittal 844.78 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-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-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-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
    FIND US AT OUR NEW ADDRESS!! 09/12/2018 (Tue)
    Form L-WAV: Fee Waiver Request 02/12/2018 (Tue)
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    PDF icon Form L-WAV164.4 KB
    Form E-100-B: Life and Health Administrator Biographical List 02/12/2018 (Tue)
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    PDF icon Form E-100-B TPA Biographical List.pdf767.11 KB
    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 E157: Bond of Life and Health Administrator 02/12/2018 (Tue)
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    PDF icon Bond of Life and Health Administrator 645.6 KB
    Form E-100-A: Life and Health Administrator Registration Addendum 02/12/2018 (Tue)
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    PDF icon Form E-100-A TPA New Application Addendum.pdf762.14 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-LR.AS: Annual Statement Filings Worksheet 03/12/2018 (Tue)
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    PDF icon Form L-RA.AS Worksheet1.11 MB
    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-AHCCCS: AHCCCS Contractor Quarterly Premium Tax Report 09/01/2019 (Fri)
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    File Form E-AHCCCS56.59 KB
    Form E-FBS: Annual Fees and Retaliation Report for a Fraternal Benefit Society 10/01/2019 (Fri)
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    PDF icon Form E-FBS (v. 20190118)898.02 KB
    Form E-II: Industrial Insured Premium Receipts Tax Report 10/01/2019 (Fri)
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    PDF icon Form E-II (v. 20190118)1.26 MB
    Form E-RT: Retaliation Report 10/01/2019 (Fri)
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    File Form E-RT (v. 20181211)78.62 KB
    Form E-SGHI: Accountable Health Plan Small-employer Group Health Insurance Plan Premium 11/01/2019 (Fri)
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    File Form E-SGHI (v. 20190117)416.73 KB
    Form E-TC: Tax Credits 11/01/2019 (Fri)
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    File Form E-TC (v. 20190118)47.91 KB
    Form E-TAX-I: Annual Tax and Fees Report Instructions 11/01/2019 (Fri)
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    PDF icon E-TAX-I: Tax Instructions389.27 KB
    Form E-TITLE: Retaliation Report for a Foreign/Alien Title Insurer 11/01/2019 (Fri)
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    File Form E-TITLE (v. 20190118)52.21 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-LRTF: Local and Regional Taxes and Fees; Survey of Arizona Domestic Insurers 12/01/2019 (Fri)
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    File Form E-LRTF (v. 20190118)1.02 MB
    Form E-TAX: Annual Tax and Fees Report 12/01/2019 (Fri)
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    File Form E-TAX (v. 20181211)88.31 KB

    Pages