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Title Last updatedsort descending Attachments
Form E126XS: Application and Order for Release of Excess Deposit 09/09/2018 (Tue)
AttachmentSize
PDF icon E126XS.pdf1.2 MB
Form E126-CD: Request for Release of Certificate of Deposit 09/09/2018 (Tue)
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PDF icon E126CD.pdf696.61 KB
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)
AttachmentSize
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)
AttachmentSize
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)
AttachmentSize
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)
AttachmentSize
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)
AttachmentSize
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)
AttachmentSize
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)
AttachmentSize
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)
AttachmentSize
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)
AttachmentSize
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-NAIC.FRATERNAL: Annual Filing Checklist 03/01/2019 (Thu)
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PDF icon E-NAIC.Fraternal.pdf245.18 KB
Form E-NAIC.TITLE: Annual Filing Checklist 03/01/2019 (Thu)
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PDF icon E-NAIC.TITLE_.pdf209.8 KB
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

Pages

Tue, 09/10/2019 - 14:27

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].