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.

    Sitemap

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    Titlesort ascending Last updated Attachments
    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
    Form E-ACTOP: Actuarial Opinion Exemption Guidelines 12/01/2019 (Tue)
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    PDF icon Actuarial Opinion Financial Hardship Exemption E-ACTOP.WebVersion.pdf747.73 KB
    Form E-857: Bond of Service Company 03/06/2018 (Tue)
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    PDF icon Form E-857 Bond of Service Company.pdf707.69 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 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-801: Motor Vehicle Dealer's Notice of Intent 03/06/2018 (Tue)
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    PDF icon Form E-801 Motor Vehicle Dealer's Notice of Intent.pdf748.71 KB
    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-800-B: Service Company Biographical List 03/06/2018 (Tue)
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    PDF icon Form E-800-B Service Company Application Biographical List.pdf726.83 KB
    Form E-711: Purchasing Group List of Insurers and Agents 03/06/2018 (Tue)
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    PDF icon Form E-711 Purchasing Group List of Insurers and Agents.pdf638.14 KB
    Form E-710: Application for Purchasing Group Registration 03/06/2018 (Tue)
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    PDF icon Form E-710 Purchasing Group Application.pdf632.76 KB
    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-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-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-653: Checklist for Change from a Provisional Permit to Life Care Provider Permit 02/06/2018 (Tue)
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    PDF icon Form E-65354.28 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-651: Checklist for Application for Life Care Provider Permit 02/06/2018 (Tue)
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    PDF icon AdmLifeCareE651.pdf52.06 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-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-178: Certificate of Disclosure 10/07/2018 (Tue)
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    PDF icon E178_20180703.pdf726.07 KB
    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 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-100: Application for Life and Health Administrator Registration 08/08/2019 (Mon)
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    PDF icon Form E-100 TPA New Application 20190809.pdf1.72 MB
    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-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 CU 1621: Credit Property/Credit Unemployment Certification of Rates 02/04/2019 (Mon)
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    PDF icon CU 1621 Certification Form.pdf694.38 KB
    Form C-TPC: Third-party Consent 08/04/2018 (Sun)
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    PDF icon Form C-TPC137.9 KB
    Form C-RFI 03/07/2018 (Mon)
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    PDF icon form_c-rfi.pdf850.66 KB
    Form 1024B: Insurer Rate Service Organization Calculation of Company Loss Cost Multiplier 08/11/2014 (Fri)
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    Microsoft Office document icon CALCULATION_OF_COMPANY_LOSS_COST_MULTIPLIER_1024B.DOC26 KB
    Form 1024B: Calculation of Company Loss Cost Multiplier 08/11/2014 (Fri)
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    PDF icon CALCULATION_OF_COMPANY_LOSS_COST_MULTIPLIER_1024B_(Fillable).pdf70.68 KB
    Form 1024A: Insurer Rate Service Organization Reference Filing Adoption Form 08/11/2014 (Fri)
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    PDF icon REFERENCE_FILING_ADOPTION_FORM_1024A_(Fillable).pdf30.92 KB
    Foreign Insurers 04/01/2020 (Thu)
    FOREIGN INSURER: Unaffiliated Credit Life & Disability Reinsurer 03/01/2019 (Fri)
    FOREIGN INSURER: Title Insurer 03/01/2019 (Fri)
    FOREIGN INSURER: Service Corporation (HMDO) 03/01/2019 (Fri)
    FOREIGN INSURER: Risk Retention Group 03/01/2019 (Fri)
    FOREIGN INSURER: Property/Casualty Insurer 07/10/2019 (Wed)

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