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NEW ADDRESS

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).

PHONE SYSTEM PROBLEMS

The State is encountering problems with its phone system not properly handling calls and dropping calls.  We apologize for any problems you encounter when trying to reach us by phone.  Our e-mail services are continuing to work well.  E-mail addresses for each area are available in the CONTACT US section of our web site.   

(5) | " (1) | 0 (650) | 1 (1500) | 2 (82) | 3 (3) | 4 (6) | 5 (6) | 6 (19) | 7 (38) | 8 (89) | 9 (356) | > (1) | A (174) | B (22) | C (138) | D (44) | E (17) | F (271) | G (18) | H (57) | I (83) | J (2) | K (1) | L (58) | M (175) | N (82) | O (22) | P (230) | Q (1) | R (205) | S (53) | T (34) | U (13) | V (4) | W (66) | Y (2) | • (1)
Title Last updatedsort descending Attachments
Form E-711: Purchasing Group List of Insurers and Agents 10/02/2020 (Wed)
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PDF icon Form E-711 Purchasing Group List of Insurers and Agents.pdf656.58 KB
FORM ER001 FOREIGN RISK RETENTION GROUP FILING INSTRUCTIONS 10/02/2020 (Wed)
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PDF icon Foreign Risk Retention Group Filing instructions E-R001.pdf164.9 KB
Form ER002: Registration 10/02/2020 (Wed)
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PDF icon Foreign Risk Retention Group Registration Application E-R002.pdf691.81 KB
Form E-857: Bond of Service Company 10/02/2020 (Wed)
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PDF icon Form E-857 Bond of Service Company.pdf729.67 KB
Form E-811: Renewal of Service Company Permit 10/02/2020 (Wed)
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PDF icon Form E-811 Service Company Renewal.pdf974.48 KB
Form E-800: Application for Service Company Permit 10/02/2020 (Wed)
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PDF icon Form E-800 Service Company Application.pdf1.01 MB
Form E-801: Motor Vehicle Dealer's Notice of Intent 10/02/2020 (Wed)
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PDF icon Form E-801 Motor Vehicle Dealer's Notice of Intent.pdf770.74 KB
Form E-800-B: Service Company Biographical List 10/02/2020 (Wed)
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PDF icon Form E-800-B Service Company Application Biographical List.pdf745.27 KB
Form E-700: Certificate of Surplus Lines Broker 10/02/2020 (Wed)
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PDF icon Certificate of Surplus Lines Broker Form E-700 (1).pdf1.24 MB
Form E-701: Certificate of Public Supervisory Official 10/02/2020 (Wed)
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PDF icon Certificate of Public Supervisory Official Form E-701 (1).pdf1.49 MB
Form SL-112: Application for Domestic Surplus Lines Insurer Designation 10/02/2020 (Wed)
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PDF icon Form SL-112 Domestic Surplus Lines Insurer.pdf806.07 KB
Form C-RFI 10/02/2020 (Thu)
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PDF icon c-rfi_20200221.pdf1.38 MB
Form SOONBDRR: Surprise Out-of-Network Billing Dispute Resolution Request 02/02/2020 (Thu)
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PDF icon SOONBDR_RequestForm_Fillable.pdf2.15 MB
Form L-BBAR: Bail Bond Agent Annual Report 11/03/2020 (Wed)
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PDF icon l-bbar_202000303.pdf111.06 KB
Form E125: Security Deposit Form 09/03/2020 (Mon)
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PDF icon E125 20200302.pdf80.53 KB
Form E126: Security Release Form 09/03/2020 (Mon)
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PDF icon E126 Security 20200302.pdf105.52 KB
Form E126 Cash: Cash Release Form 09/03/2020 (Mon)
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PDF icon E126 Cash 20200302.pdf192.75 KB
Filing a Health Care Appeal 10/03/2020 (Wed)
Form E185: Outline for Compliance with Insurance Holding Company Systems Reporting Requirements 01/03/2020 (Mon)
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PDF icon Holding Company Instructions E-185 (1).pdf213.84 KB
Form E-CR-INFO: Certified Reinsurer Information 01/03/2020 (Mon)
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PDF icon Certified Reinsurer E-CR-INFO Information 20200314.pdf161.25 KB
Form E-NAIC.PC: Annual Filing Checklist 01/03/2020 (Mon)
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PDF icon E-NAIC.PC (3).pdf262.88 KB
Form E-AR-1: Certificate of Assuming Insurer 10/03/2020 (Fri)
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PDF icon Reinsurer E-AR-1 Certificate of Assuming Insurer.pdf811.39 KB

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