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 descending Last updated Attachments
    Form ER001: Filing Instructions 04/02/2015 (Wed)
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    PDF icon Form ER001: Filing Instructions153.63 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 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 EXSAPP: Application for Workers' Compensation Deposit Reduction - Instructions 12/06/2015 (Tue)
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    PDF icon EXSAPP.pdf204.59 KB
    Form F101: Fraud Referral Form 05/04/2019 (Sat)
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    PDF icon Form F-101: Fraud Referral Form219.47 KB
    Form HIPAADATA: HIPAA Report 09/05/2015 (Fri)
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    PDF icon HIPAADATA FORM 2015 PDF.pdf50.91 KB
    Form II-Certification: Industrial Insured Certification 03/03/2015 (Mon)
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    PDF icon Industrial Insured Certification (01-2015) New Heading.pdf18.47 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-176: Insurance License Application for a Business Entity 03/07/2019 (Fri)
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    PDF icon L-176-Form-and-Instructions_20190712.pdf477.29 KB
    Form L-177: Report of a Change to Members, Officers or Directors 01/02/2019 (Wed)
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    PDF icon Form L-177618.01 KB
    Form L-191: License Renewal Application for an Individual 12/07/2019 (Mon)
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    PDF icon form_l-191_0.pdf314.72 KB
    Form L-192: License Renewal Application for a Business Entity 02/04/2019 (Tue)
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    File l-192_20190402.docx81.02 KB
    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-195: Bond of Bail Bond Agent 01/08/2018 (Fri)
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    PDF icon l-195_20180618.pdf893.64 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-BBAR: Bail Bond Agent Annual Report 02/02/2019 (Wed)
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    PDF icon Form L-BBAR (v. 20190118)1.02 MB
    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-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-CHG: License Information Change 01/08/2018 (Fri)
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    PDF icon l-chg_20180618.pdf949.18 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-CRT: Certification Letter Request 02/04/2019 (Tue)
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    PDF icon form_l-crt_e_04022019.pdf999.65 KB
    Form L-CRT: Letter of Certification Request 09/06/2019 (Fri)
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    PDF icon form_l-crt_e_.pdf999.65 KB
    Form L-FPV: Fingerprint Verification 01/08/2018 (Fri)
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    PDF icon l-fpv_20180618.pdf62 KB
    Form L-HFAI-INST: Instructions for Using the Health Filing Access Interface (HFAI) 04/01/2015 (Thu)
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    PDF icon L-HFAI-INST.pdf83.08 KB
    Form L-LOC: Branch Locations 01/08/2018 (Fri)
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    PDF icon l-loc_20180618.pdf1.03 MB
    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-LTD: Limited License Authority Application 10/05/2019 (Tue)
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    PDF icon l-ltd_20180618.pdf240.58 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-PFD: Petition for Determination 01/08/2018 (Fri)
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    PDF icon Form L-PFD216.64 KB
    Form L-SURR: License Surrender Request 01/08/2018 (Fri)
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    PDF icon l-surr_20180618.pdf1.02 MB
    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-WAV: Fee Waiver Request 02/12/2018 (Tue)
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    PDF icon Form L-WAV164.4 KB
    Form LTCPP-AZ Attachment A: Insurer Certification Form 03/12/2014 (Mon)
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    PDF icon LTCPP_INSURER_CERTIFICATION_FORM_2-4-10_rvsd.pdf267.45 KB
    Form LTCPP-AZ Attachment B: Pre-purchase Notice 03/12/2014 (Mon)
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    PDF icon LTCPP_PRE-PURCHASE_NOTICE.pdf139.46 KB
    Form LTCPP-AZ Attachment C: Post-purchase Notice 03/12/2014 (Mon)
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    PDF icon LTCPP_POST-PURCHASE_NOTICE.pdf110.03 KB
    Form P-LSA: Life Settlement Provider/Broker Disclosures to Owner; Affiliations 09/11/2014 (Thu)
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    PDF icon p-lsa.pdf969.43 KB

    Pages